Other

By submitting my information, photo, and/or video, I give Children with Diabetes permission to use my story, imagery, photograph(s), and/or video(s), in its promotional materials and publicity efforts. I understand that the imagery may be used in, but not limited to, a publication, print ad, direct-mail piece, electronic media, or other form or promotion; and that my name and additional information collected by the organization may be used in conjunction with the image(s). I release Children with Diabetes from liability for any violation of any personal or proprietary right I may have in connection with such use.