Body/Language: Speaking Out About Body Image and Eating Issues
February 26th, 6-8PM University Union: Potomac Lounge
Name:
Address:
Phone Number:
Email Address:
TU Status (i.e. freshman, etc):
Major:
Check all that apply. Please be aware that choosing some options may impact whether your piece is chosen for inclusion in the program.
___ I am submitting this piece with the understanding that confidentiality does not apply. My piece will be read by members of the Body/Language committee with possible follow up regarding the submission.
___ I am available and interested in reading my piece during the event on February 26th
___ I am interested in my piece being considered for Grub Street, Towson’s literary magazine.
___ I am interested in my piece being considered for online posting.
___ I would like to use a pen name for print (both online and in Grub Street) in order to maintain some anonymity. My preference is: _________________________
___ I am currently struggling with body image and eating issues. I have thought about whether an involvement in this program would be detrimental to my recovery.
___________________________________________________ ____________
Print Name as Signature Date