Share Your Success Story

You Could Be Featured On A Future Blog Post, Video, Or Podcast!

* Indicates required field

Name *

First

Last

Email *

Before Photo (Or Self-Photo) *

Max file size: 20MB

After Photo *

Max file size: 20MB

Your Story (How Did You Do it?) Be Detailed! *

Choose One *

I Give Full Permission To Use My Image And Story On HealthHumorLife.com I do not give permission to use my image and story.

Digital Signature *

Date *

By Checking The Box Below, You Agree To These Terms of Service.

By Checking The Box Below, You Agree To These Terms of Service.

I hereby grant HealthHumorLife.com and their designees (the “licensees”), the right and permission to use my image or work (audio recording, song, video, photo, blog, character) for no additional charge, fee or consideration, and for the purpose of utilizing it within any created content produced by HealthHumorLife. (including but not limited to, any promotional projects, services, videos, etc. whether offered free or for profit)

I hereby release, and shall hold licensees harmless from, any and all claims and demands arising out of or in connection with the use of such photos, audio recordings, songs, or videos, including but not limited to, all claims for wages, compensation, royalties, libel, defamation, costs, and attorney's fees aside from the agreement specified above.

I hereby waive any rights I may have to inspect or approve the finished product or products that may be used in connection with such advertising, videos, or other uses.

I am aware that I have the right to revoke this permission at any time with a dated, and signed letter scanned and sent to healthhumorlife@gmail.com. The termination of the permission will result in HealthHumorLife stopping the use of any videos, photos, audio recordings, or songs being produced after the revocation of this permission. However, to the extent that photos and videos have been prepared and/or disseminated they may continue to be used (and remain posted on the website, YouTube, social network accounts etc.) as though the permission had not been revoked.

I agree to be contacted by HealthHumorLife.com

Choose Any *

I Agree With The Terms Of Service

Submit