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I hereby grant the American Lung Association, its representatives, constituent offices and employees the right to use my personal story, name and/or likeness as provided by me or in the submitted photograph(s)/video footage for reproduction in all web, print, video or any and all other media, whether now known or hereafter existing, prepared and controlled by the American Lung Association, in perpetuity. This may include edited copy for fundraising appeals. I will make no monetary claim against the American Lung Association for the use of the content and/or photograph(s). I also understand I do not own copyrights for said content and/or photograph(s) once submitted.

I have read and understand the above.

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Check this box if story or photographed subject is younger than 18 years of age, as a parent or guardian must sign this form.

Page last updated: August 14, 2024

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