Awareness Flyer Submission & Release

Awareness Flyer Request
Your Name*

First NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
Child's Name*

First NameLast Name
Does your child have a Page with GP2C?*

YesNo
If NO, You can create one by CLICKING HERE

Once your child's page has been created, we will add your child's page to the Awareness Flyer. Please make sure to insert the link BELOW.
Please lets us know the link to your child's Faces of Rett Page, OR if you would like us to use the GP2C URL (www.gp2c.org) - Please specify*
Photo/s Upload*

Upload a File
Upload up to 10 MB of multiple files - High Res Files Preferred-Otherwise quality might be compromised Cancelof
Optional Photo Release
P H O T O R E L E A S E

We are always looking for photos of our girls and boys to help tell the Rett Syndrome story. If you would like to give us permission to use your uploaded photo(s) for other GP2C Awareness materials, please sign this release.

By signing below, I (Parent) am agreeing to allow Girl Power 2 Cure the rights of my image, without payment or any other consideration. I understand that my image may be edited,copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my daughter's likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image.This photograph(s) may be used in publications, including electronic publications, or in audiovisual presentations, promotional literature, advertising, or in other similar, lawful ways solely pertaining to the direct mission of the GP2C organization. By typing your name, you agree to the terms listed above.
Parent Signature
Should be Empty:

Awareness Flyer Request

Optional Photo Release