Content Release and Opt-in Submission Form

Health Stories Project/Reverba is collecting and storing information about my health condition. By my signature below, I hereby allow Health Stories Project/Reverba and its officers, directors, employees, agents, contractors, subsidiaries, affiliates, successors and assigns to contact me regarding any activities I have said I am interested in, as well as to share information regarding my identity and my health condition with trusted partners outside of Health Stories Project/Reverba who may be considering me for participation in activities. Please note: Due to limited space for select activities, not everyone interested in participating may be selected to do so.

By my signature below, I hereby release Health Stories Project/Reverba, and its officers, directors, employees, agents, contractors, subsidiaries, affiliates, successors and assigns from any and all claims, demands, causes of actions or the like that I may have or may in the future have relating to any utilization of the rights granted by me under this Release Form.

I understand that I may opt out, modify or remove my Personal Information from the Health Stories Project database by contacting Health Stories Project/Reverba at team@HealthStoriesProject.com. I understand that Health Stories Project/Reverba may not accommodate a request to change or remove information if they believe the change would violate any law or legal requirement or cause the information to be incorrect. Information that has been de-identified, anonymized, and/or aggregated may not be retrievable or traced back for destruction, deletion or modification. Some information may be retained in Health Stories Project/Reverba files to prevent fraud, troubleshoot problems, assist with any investigations, enforce their Terms of Use and/or comply with legal requirements. Please view the Health Stories Project privacy policy at http://HealthStoriesProject.com/privacy-policy/.