I grant America's Health Insurance Plans (AHIP) the right and permission to use, in whole or in part, my name, address, story, image, voice and other information about my personal experience with long-term care insurance, in any way, including, on and in the internet, web sites, print, radio, television or any other media and by distributing it to the media, members of Congress, or any other entity or person in the United States and throughout the world. I understand that my story may include my medical information and other personal information. I also understand that minor editorial changes may be made to my story, but that no material changes will be made to my story without my permission. I also agree to accept potential inquiries from the media.

I understand that if I no longer want to grant AHIP permission to use my name, address, story and information about my personal experience with long-term care, I can contact AHIP at info@mylifemyfamily.com.