AstraZeneca Sponsors DBSA contest for bipolar and depression:
To submit your entry online, please visit http://www.speakaboutdepression.com/.
Submissions may be mailed to:
Edelman
Attn: David Barton
250 Hudson StreetNew York, NY 10013
ENTRY FORM SUBMISSIONS *GUIDELINES
Submissions for all categories will be accepted starting on July 20, 2010. To qualify, submis-sions must be received by the following dates for each category:Essay, Song, and Poetry Categories: July 20 - August 13, 2010
Art and Video Categories: July 20 - September 10, 2010For each of the submission categories, judges from patient, advocacy, health care, literary, film, music and art communi-ties will select three entrants as finalists. The judges will be looking for submissions that inspire hope in others so they canrecognize and seek help for their unresolved depressive symptoms of bipolar disorder or major depressive disorder.
Criteria used to evaluate the submission for patient stories:
Number of years diagnosed with bipolar disorder or major depressive disorderHow did your unresolved symptoms affect your life?Your journey to successfully achieve your goals and the importance of managing unresolved de-pressive symptoms of bipolar disorder or major depressive disorder to achieve those goalsWords of advice for others, how to manage the depressive symptoms of his or her bipolar disor-der or major depressive disorder, and how to seek to achieve their goals
Contact information including: name, address, phone number, and e-mail addressSubmissions must not include any mention of specific treatments or brand names of medications, or full names of medicalprofessionals, patients, caregivers, family members, or other individuals. Any entries that include this information will bedisqualified. Additionally, for people with bipolar disorder, entries should not include descriptions of manic episodes or theywill be disqualified as well.
The contact information provided will be used solely to communicate with you about your submission and this contest,and will not be used or disclosed for any other purpose unless you check that appropriate box on the authorization form(electric and hardcopy).
*Submissions will not be returned. Per the authorization form (electric and hardcopy), you give DBSA and AstraZeneca permission to use, reproduce, and disclose your submission in the United States, in any media, including radio, television,print publications, and the Internet (including DBSA and AstraZeneca web properties) for purposes of educating peopleon bipolar disorder and major depressive disorder through educational, promotional, and commercial programs that arerelated to the SPEAK and Be Heard … Living with Depression program.
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OFFICIAL ENTRY FORMFIRST NAME:LAST NAME:DATE OF BIRTH: (I REPRESENT THAT I AM AT LEAST 19 YEARS OLD)STREET ADDRESS:CITY, STATE, ZIP:PHONE:E-MAIL:TITLE OF ENTRY:The contact information provided will be used solely to communicate with you about your essay/video/art/poem/song sub-mission and this contest, and will not be used or disclosed for any other purpose unless you check that appropriate box onthe authorization form.I have been diagnosed with bipolar disorder for_________ (insert number of months and/or years) and am currently tak-ing medication(s) for my bipolar disorder. Please note that you must have been diagnosed and successfully treated for aminimum of six months to submit an entry. Also, entries should not include descriptions of manic episodes or they will bedisqualified.I have been diagnosed with major depressive disorder for_________ (insert number of months and/or years) and am cur-rently taking medication(s) for my major depressive disorder. Please note that you must have been diagnosed and suc-cessfully treated for a minimum of six months to submit an entry.Thought Starters to Consider for Your Entry:How did your unresolved symptoms affect you?How did your unresolved depressive symptoms of bipolar disorder or major depressive disorder affect your life (e.g.work, family, relationships, education, home, hobbies, etc.)?What were some of the challenges you faced before seeking help for your unresolved symptoms?What impact did this have on you? On your family or loved ones?Back on TrackWhat goals did you set for yourself?How did you successfully manage your depressive symptoms in order to achieve your goals?Do you feel that your depressive symptoms have improved enough to start planning for the future?Please check the appropriate box to tell us what category you are submitting your success story to:EssayVideoArtworkPoemSongPlease check the appropriate box to tell us how you heard about this program:
News (print, broadcast or online)DBSA CommunicationFacebook or TwitterMy friend or family memberOther
Please Print Clearly
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Authorization for Release of Identifying Health InformationThis Authorization describes how the identifying and health information about you, as well as your story of successthat is contained in your essay/video/art/poem/song submission for the SPEAK and Be Heard … Living with Depres-sion campaign may be used and disclosed by DBSA and AstraZeneca to the public. Please review the terms of thisAuthorization carefully. You must sign a copy of this Authorization and submit with your entry in order to be eligiblefor participation in this program.NAME:ADDRESS:CITY, STATE, ZIP:PHONE:E-MAIL:DATE OF BIRTH: (I REPRESENT THAT I AM AT LEAST 19 YEARS OLD)The contact information provided above will be used solely to communicate with you about your essay/video/art/poem/song submission and this program, and will not be used to disclose for any other purpose unless, you check the box be-low.Check here if you give DBSA and AstraZeneca permission to contact you about the possibility of using your essay/video/art/poem/song submission in connection with future DBSA initiatives and/or unbranded AstraZeneca campaigns.Even if you check this box, your submission will not be used for these purposes unless you consent at that time.I understand that the purpose of this program is to educate the public and inspire those with depressive symptoms ofbipolar disorder or major depressive disorder, which is also called depression, by sharing stories of success in managingthe symptoms of depression. I authorize the Depression and Bipolar Support Alliance (“DBSA”), a patient-directed national organization, and AstraZeneca Pharmaceuticals LP (“AstraZeneca”) to use, reproduce, and disclose my submission in theUnited States, in any media, including radio, television, print publications, video, and the Internet, which may include, butare not limited to, social networking media for purposes of educating people on bipolar disorder and depression througheducational, promotional, and commercial programs that are related to the SPEAK and Be Heard … Living with De-pression program. Additionally, I understand that DBSA and AstraZeneca may contact me regarding my essay/video/art/poem/song submission to use, reproduce, and disclose my submission in the United States, in any media, including radio,television, print publications, video, and the Internet, which may include, but are not limited to, social networking media forpurposes of educating people on bipolar disorder and depression through educational programs.I also represent that all of my submitted statements are true, accurate, and reflect my honest opinion, and that my essay/video/art/poem/song submission is original and personally created. I also represent that I own the rights to any photo-graphs, poems, artwork, or other materials that I submit to DBSA and AstraZeneca, and that their use of these materialswill not violate or infringe the rights of any third-party. DBSA and AstraZeneca may use all or any part of my essay/video/art/poem/song, and I agree that I will not have the right to review or approve the manner in which it i payments of anykind and I understand that I will receive no fee or othercompensation from DBSA and AstraZeneca. I also agree that I willnot hold DBSA, AstraZeneca, or anyone who receives permission from it responsible for any liability arising out of theuse of my name, initials, likeness, photograph, or statements in accordance with the terms hereof, including what may bedeemed to be any distortion or optical illusion in the finished materials.
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I understand that my submission must not include any mention of specific treatments or brand names of medications, orfull names of medical professionals, patients, caregivers, family members, or other individuals. Any entries that includethis information will be disqualified. Additionally, if I have bipolar disorder, I understand that my entry should not includedescriptions of manic episodes or it will be disqualified as well. Furthermore, I understand that in submitting my essay/video/art/poem/song my full name will not be disclosed but I may be identifiable from the medical and personal informa-tion contained in the entry. I understand that I must obtain the consent of any other person included in my submission thatcould also be identified, as, for example, when they are included in a video clip or artwork. I understand that once I havesigned this Authorization, I cannot change my mind and cancel it. I have read this release form carefully and fully under-stand its meaning and implications.Signature: ______________________________________Printed Name: __________________________________Date: __________________________________________Please send a signed copy of this Authorization to:
Edelman
Attn: David Barton250 Hudson StreetNew York, NY 10013
Please keep a full copy of this Authorization for your records.
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*the above is the entry form for the contest
MORE
"I also agree that I willnot hold DBSA, AstraZeneca, or anyone who receives permission from it responsible for any liability arising out of theuse of my name, initials, likeness, photograph, or statements in accordance with the terms hereof, including what may bedeemed to be any distortion or optical illusion in the finished materials."
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Distorted images or optical illusions? and who is 'anyone' who receives permission from them?
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See previous post:
Friday, July 23, 2010
AstraZeneca sponsors DBSA National Contest: Living With Depression, Bipolar & MDD
AstraZeneca, makers of the antipsychotic SEROQUEL has teamed up with DBSA (Depression Bipolar Support Alliance) by funding a National Contest:
From AstraZeneca's website:
National contest encourages people with depressive symptoms of bipolar disorder or major depressive disorder to speak out
July 20, 2010 – Wilmington, DE – Currently in its second year, the SPEAK and Be Heard… Living With Depression contest, made possible by AstraZeneca in partnership with the Depression and Bipolar Support Alliance (DBSA), encourages people with depressive symptoms of bipolar disorder and major depressive disorder (also called depression) to share their stories of success.
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