* I do hereby grant permission to the Minnesota Department of Health (MDH) and their respective designees to use my name and likeness for advertising and promotional purposes in any and all media throughout the world in perpetuity at their discretion without compensation, notice, consent or right of review unless prohibited by law. MDH may contact me for clarifications or additional information related to my submission. I understand that these materials will be used for the purpose of informing and educating the public about MDH programs and activities. I further understand and agree that these photographic or video or audio images may be publicly distributed or displayed in connection with MDH informational programs and activities. MDH shall have a non-exclusive, fully-paid up and royalty-free license to the story submission and any photography, video or audio submitted, and may edit, and/or modify, including, without limitation, the names and likenesses of any persons or locations embodied therein without compensation, permission or notification.

I further waive any rights and release any claims or causes of action I may have to object to, prevent or seek damages for the release, publication or use of the above images or audio under the Minnesota Data Practices Act (Minnesota Statutes, chapter 13) and any claims or causes of action I may have based on, arising from or related to invasion of privacy. I also understand that refusal to grant such permission would not and cannot result in the loss of any rights to which I am otherwise entitled by law.