Optional Photo and Information Consent Form
By signing this form, I give permission to Dental Lifeline Network to use my name, information, statements, or photographs for public relations purposes, and to attribute my statements to me as an expression of my personal experience. I understand that this information may be used in dental publications, website(s), media articles, advertisements or other marketing materials that promote the programs of the organization and encourage involvement from dental professionals and funders. I also agree that no material needs to be submitted to me for any further approval, and I give the organization the right to copyright such material if necessary.