By completing this form I hereby give Healthcare Workers Rising my permission to use images and video of me and comments made by me in printed material, videos, digital and online media, advertisements, and any other materials without payment to me for such use.

I acknowledge and agree that Healthcare Workers Rising, shall have sole ownership rights to any images and video of me and comments made by me which are contained in any printed material, videos, digital and online media, advertisements, and any other material, and hereby relinquish and waive any ownership interest which I have in such material, to the extent that any such interest exists.

I further acknowledge and agree that Healthcare Workers Rising, as sole owner of any images and video of me and comments made by me, shall have the right, in its sole discretion, to edit any images and video of me and comments made by me which are contained in any printed material, videos, digital and online media, advertisements, and any other material without payment to me.