Dear Lupus Terms and Conditions
I certify that I am at least 18 years old. I am submitting information for myself or I am the legal guardian submitting information on behalf of my child. I grant permission to the Lupus Foundation of America, Inc. (LFA), their successors, assigns, and those acting on their authority to publish or share the story I am submitting. I further warrant that the story herewith was prepared by myself (or someone directed by me) and is true and accurate.
I further understand that this material may possibly be re-titled and/or reprinted in other LFA publications or shared with the news media and made public.
I acknowledge that I have not included any information in my submission that I wish to keep private. I possess full legal capacity to exercise this authorization and hereby release Lupus Foundation of America, Inc. and its officers, employees and agents from any blame by myself, my successors, and/or my assigns. This authorization shall remain in force until canceled by me, but I recognize that withdrawal of authorization cannot be made retroactive to those who have received my information prior to my notification.
I understand that to cancel authorization for future releases of my story, I must send an email to email@example.com with my name and address and any additional information that may be helpful to identify my profile and story in the database.