Share Your Story

Consent to Share My Story

In order to support the DetecTogether in its mission of promoting early cancer detection awareness, I agree to the terms of this Authorization and Release with the DetecTogether, its affiliates, directors, officers, employees, agents, volunteers and representatives (“DetecTogether “). I agree to serve as a volunteer spokesperson on behalf of DetecTogether to further its mission promoting early cancer detection for people of all ages. I will share my Learn From Others story, (the term “Learn From Others” includes, among other things, my medical information), with DetecTogether, the public, and parties working with DetecTogether in support of its mission. I understand and agree that DetecTogether may share my Learn From Others story, and my name and contact information with various media outlets including newspapers, public relations agencies, television, radio, websites, magazines, and with any other third-parties working with DetecTogether to provide educational information on early cancer detection to the general public, for consideration for use in the DetecTogether’s public relations, campaigns, and educational promotions and materials. DetecTogether may introduce me to media representatives, but DetecTogether has no obligation to do so. I will give interviews on my Learn From Others story for use and publication on social media and websites and in newspapers, magazines, television, radio or other media or with other third-parties working with DetecTogether and will do so upon request of DetecTogether.

I assign to DetecTogether the right to use medical information about me. I also acknowledge that I have enough facts about the disclosure of the medical information to understand and consent to the disclosure. I understand that DetecTogether might, in its sole discretion, undertake a production, or a derivation, whether recorded on or transferred to print, videotape, presentations, film, photographs, audio tapes, website, internet, social media, electronic media or other media, now known or later developed, of my Learn From Others story (“Production”) and that my name, likeness, image, voice, appearance, performance and/or written words submitted to DetecTogether might be made a part of the Production.

I grant DetecTogether and its designees the right to use my name, likeness, image, voice, appearance, performance and/or written words submitted to DetecTogether as embodied in the Production or any derivation, whether recorded on or transferred to print, videotape, film, presentations, photographs, audio tapes, website, internet, social media, electronic media or other media, now known or later developed. This grant includes without limitation the right to edit, mix or duplicate and to use or re-use the Production in whole or part as DetecTogether may elect. DetecTogether and its designees shall have complete ownership of the Production in which I appear, including copyright interest, and I acknowledge that I have no interest or ownership in the Production or its copyright. DetecTogether, is a 501c3, not-for-profit organization dedicated to empowering you with the lifesaving advantage of early cancer detection.

I also grant DetecTogether and its designees the right to broadcast, exhibit, publish, and otherwise distribute the Production either in whole or in part, and either alone or with other products, for commercial or non-commercial use or any other purpose DetecTogether or its designees in their sole discretion may determine.

I confirm that I have the right to enter into this Agreement, that I am not restricted by any other commitment and that DetecTogether has no financial commitment or obligation to me as a result of this Agreement. It is my understanding that I will receive no compensation for my likeness or testimonial and I will not be paid, compensated, or reimbursed in any way for current or future use of the Production, presentations, or my Learn From Others story, except possibly for travel expenses as the DetecTogether and I might later agree in writing.

I hereby give all clearance, copyright and otherwise, for use of my name, likeness, image, voice, appearance, story, and performance embodied in the Production. All of the statements that I give in my Learn From Others story or other materials submitted are true to the best of my knowledge. I expressly release and indemnify DetecTogether from any and all claims known and unknown arising out of or in any way connected with the above granted uses and representations. The rights granted the DetecTogether herein are perpetual and worldwide.

If I am asked to share my story in a presentation where minors are present, I verify that I have no criminal record or other reason that would not permit me to do so. I am willing to submit to a criminal background check if requested.

I am 18 years of age or older and of sound mind to contract in my name. I have read the release before signing below, and have read and fully understood, and consent to the contents of this release. I am aware that I am free to address any questions prior to the signing of this release and failure to do so will be considered as a free and knowledgeable acceptance of the terms of the release.

Media Release (Video & Photo)

I grant permission to DetecTogether, to use or post my image (s) (videos and/or photographs, hereby referred to as “Materials”) for use in DetecTogether publications, including but not limited to video, magazines, newsletters, general publications, marketing materials, e-mails, websites and/or affiliates.

I hereby waive my right to inspect and/or approve the Materials, whether they are known to me or not, and whether for present or future use. I shall receive no compensation nor royalties arising from the said use of the Materials.

I am 18 years of age or older and of sound mind to contract in my name. I have read the release before signing below, and have read and fully understood, and consent to the contents of this release. I am aware that I am free to address any questions prior to the signing of this release and failure to do so will be considered as a free and knowledgeable acceptance of the terms of the release.