Share Your Story
Release of Likeness
Name:
Organization: *
Phone:
Email:
I am a: Donor Recipient Volunteer Employee Other
Summary of My Story:
Attach Document:
Upload Photo:
Please Notify Me if My Story is Used:
I hereby give Memorial Blood Centers and its assignees the irrevocable right and permission to use and reproduce my name and personal story information and photos, videotapes, film and/or recordings for any and all purposes in perpetuity. I represent that I am at least 18 years of age, have read the above information, and I fully and completely understand the contents.
All fields are required unless marked with an asterisk (*)