I grant the James D. Moore Memorial Foundation for Sepsis Awareness (JDMM Foundation) permission to use my story and/or its likeness and any photographs provided in any and all of its publications, including web site entries, without payment or other consideration to help further its mission/cause.

I understand and agree that I have submitted these materials to the JDMM Foundation voluntarily and they will become the property of the JDMM Foundation and will not be returned.

I irrevocably authorize the JDMM Foundation and/or its agents to edit, alter, copy, exhibit, publish, distribute or not use my story for purposes of publicizing the JDMM Foundation or for any other lawful purpose.

In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my information appears.

Additionally, I understand that I will not receive any royalties or other compensation arising from or related to the use of the information. I hold harmless the JDMM Foundation from any claims, demand, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization or the use of my story, likeness, and photos.

I certify by checking the consent box on the share your story submission page that I am 18 year of age and am competent to contract in my own name.