Tell us your story...

In the space provided below, please share your story limiting the description to 750 words or less. While it is not possible to respond to each of your submissions, we will do our best to do so.

* Indicates a required field
First Name* Street Address*
Last Name* Apt# (if applicable)
Email* City*
Home Phone* State*
Cell Phone Country*
Age* Zip/Postal Code*
if you are under the age of 18, your parent/guardian must fill this out with his/her info and then tell your story on your behalf.

All material related to the story submitted above (hereafter referred to "Materials") become the sole and exclusive property of the producer of RENEWAL and will not be returned at any time. Through your submission for consideration, you agree that the producer may use the "Materials" in connection with the RENEWAL show but is not obligated to do so. Additionally, the producer may use the "Materials" in any medium, worldwide and in perpetuity. You warrant that all "Materials" are 100% true and authentic, original and do not violate the right of privacy or publicity of, or constitute a defamation against any person or entity. You also agree that the "Materials" will not infringe upon or violate the copyright or common law rights or any other rights of any person or entity. In addition, you agree that there are and will be no encumbrances, liens, conditions or restrictions whatsoever upon or affecting such "Materials". You warrant that you are at least 18 years of age and the person depicted in the "Materials". You agree to indemnify producer of RENEWAL and broadcaster as well as Dr. Terry Gordon, LLC for all damages and expenses (including reasonable attorney's fees) arising out of any breach or failure of the warranties made herein.