NER Video Submission Form | Diocese of Lafayette | Lafayette, IN

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NER Video Submission Form
- The maximum number of form submissions has been reached. This form is currently not available.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Pastorate Name REQUIRED Please fill out this field. Please enter valid data.
  
  Write Your Own Video Caption REQUIRED Please fill out this field.
  
  Paste Link to Video Here REQUIRED Please fill out this field. Please enter valid data.
  
  Are you 18 years of age or above? REQUIRED Please fill out this field.
  
  I understand that, by providing a link to my video to the diocese, it may be shared on various social media and web-based platforms, including but not limited to the diocesan web site, Twitter, and Facebook.
  
  If the video includes minor children, I allow my child’s image to be featured by the diocese.
  
  I certify that the video is my own creation and does not include any copyrighted works owned by someone else.
  I Agree Please select this field.
  
  Submit
  
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