Sharing your fertility story provides hope

Rights Granted to Fertility Answers, LLC

The undersigned, the subject of Fertility Answers Patient Story (known in this agreement and release collectively as “Subject”), grants and conveys to Fertility Answers the exclusive rights to develop, tell and share the Subject’s story related to her/his efforts to build a family, including but not limited to, information regarding the Subject and her/his partner; any third parties, with additional consent given by said parties, such as a gestational carrier or surrogate; the Subject’s medical and financial struggles related to pregnancy, pregnancy loss, infertility, fertility treatment, and the like; images of the Subject, Subject’s partner, family members and other third parties (known in this agreement and release collectively as your “Story”) for the purpose of patient education and marketing. Subject grants Fertility Answers the exclusive right to share, now and hereafter, her/his Story in all media, now and hereafter developed, including but not limited to, print and broadcast media, and electronic media including all websites and social media platforms owned and operated by Fertility Answers.

Subject agrees to be truthful with respect to all information provided to Fertility Answers for inclusion in Subject’s Story. Subject understands that providing incomplete, inaccurate, or false information will cause significant harm to Fertility Answers and agrees to indemnify and hold Fertility Answers harmless against any claim, demand, or recovery brought against Fertility Answers as publisher of the Subject’s Story with respect to any information Subject provides that is not complete, correct, accurate and truthful.

Subject agrees to provide Fertility Answers and/or its representatives or agents with photographs of Subject, Subject’s partner, and immediate family members and additional information to facilitate the telling of Subject’s Story, if applicable and as requested by Fertility Answers. Subject agrees to allow Fertility Answers and/or its representatives or agents to attend, photograph, videotape and otherwise record for purposes of telling Subject’s Story, medical appointments and other events related to Subject’s efforts to build a family, if applicable and pertinent to the Story.

Subject agrees and understands that she/he shall receive no compensation for granting these rights. Subject hereby waives claim to any royalties, fees or other compensation Fertility Answers may receive related to publishing or other telling of Subject’s Story.

Rights Granted to Subject

Subject understands this authorization will remain in effect until a request for the removal of the information is made. Subject has the right to revoke this authorization at any time through written notice. Upon receipt and within 30 days, Fertility Answers will remove Subject’s Story from all electronic media, such as websites and social media platforms, owned and operated by Fertility Answers, and destroy any print or electronic media in possession of Fertility Answers. Subject understands that, given the nature of media, Subject’s Story may have been photocopied, shared, republished, screenshot, or otherwise redistributed beyond the control of Fertility Answers.

THE UNDERSIGNED SUBJECT HAS READ AND UNDERSTANDS THE RIGHTS GRANTED TO FERTILITY ANSWERS, LLC IN THIS COPYRIGHT AND MEDIA RELEASE AND VOLUNTARILY GRANTS THE RIGHTS DETAILED IN THIS RELEASE TO FERTILITY ANSWERS, LLC.