Become a maternal health Champion! Submit your experience below and gain access to our Champions Training Center Facebook Group and free training.
Story Submission Form

Photos * Videos * Audio * Art * Writings * Stories


I hereby authorize and consent to the Preeclampsia Foundation, a US-based 501(c)(3) nonprofit organization (the “Foundation”), and its subsidiaries, affiliates, designees, successors, and assignees (collectively, the "Permitted Parties"), capturing, modifying and reproducing my image, likeness and voice through still photographs, video tape, digital photography, digital recording or any other means, including color, partial or composite renditions of the same, singularly or in conjunction with other recordings (all of which are collectively referred to herein as the “Recordings”) for advertising, publicity, commercial, business and/or any other lawful purpose(s) in any medium, whatsoever, for use in all domestic and foreign markets and on the Foundation's website (the “Permitted Uses”). In conjunction therewith, I hereby grant the Permitted Parties a world-wide, royalty free, perpetual, non-exclusive license to copyright, modify, publish, broadcast, and/or otherwise use Recordings of me for any one (1) or more of the Permitted Uses.


I agree that my likeness / voice / image may be edited and used by the Permitted Parties in whole or part for print, radio, cable, broadcast, or non- broadcast purposes, and/or for audio or video exhibition purposes in any manner of media, in perpetuity throughout the world.


I also hereby expressly consent to the Permitted Parties’ use of personal biographical information about me in connection with the Permitted Uses. I expressly release the Permitted Parties and all individuals and/or organizations involved in the production of Recordings from any privacy, defamation, or other claims that I may have arising out of the use of Recordings for any Permitted Use.


The Permitted Parties have my permission to use my photograph, art or written material, story, audiotape or videotape for training and education purposes, brochures, website, other promotional or informational materials for the purpose of educating or informing others about preeclampsia, the Foundation and its programs.


I understand that I will not receive compensation for any Permitted Use of any Recordings.