Consent to publish story

For good and valuable consideration, receipt of which I hereby acknowledge, I specifically grant to Planned Parenthood Action Fund, Inc. and Planned Parenthood Federation of America, Inc. (“Planned Parenthood ”) and their affiliates, successors and assigns, and to such other persons as Planned Parenthood may designate from time to time (“Licensees”), the absolute and irrevocable right to take, use, publish, reproduce, and distribute my story as written on this form, with the limitations, if any, described on this form, in the United States or elsewhere in the world at any time in perpetuity.I agree that any pictures or images taken of me or sound recorded of me by the Licensees are owned by them, including any reproductions, derivatives or alterations thereof. If I should receive any photograph, image or recording from Planned Parenthood, I shall not authorize its use by anyone else.Without limiting any of the foregoing, I (1) irrevocably consent to and authorize the reproduction, alteration and publication of my story, images or recordings, in whole or in part or in conjunction with other photographs, images, audio recordings and/or text, or in any altered or derivative forms, without any further compensation to me and (2) specifically waive any right to inspect or approve the final photography, images or recordings (or any derivatives or alterations thereof) that may be taken, used, published, reproduced, distributed or copyrighted hereunder.I specifically release Licensees and all personnel associated with Licensees of any and all liability to me and/or my property of any and every nature, including but not limited to any and all claims of defamation, privacy or publicity, arising out of the use or uses of my name, voice, likeness, photography, image or recording as contemplated herein. I further agree that I will not hold Licensees, or anyone who receives permission from Licensees, responsible for any liability resulting from the use of my name, story, voice, portrait, likeness, photograph(s), image(s) and/or recording(s) in accordance with the terms hereof, including what might be deemed to be misrepresentation of me, my character or my person due to distortion, optical illusion or faulty reproduction which may occur in the finished product.I warrant and represent that this license does not in any way conflict with any existing commitment on my part.