ISN Photo Repository Submission and Copyright Agreement Form

ISN Photo Repository Photo Donation Form

Please Submit This Form, then Email Your Symptom Photo(s)

Use this form to donate your photos to the ISN Photo Repository, for the nonprofit International Scleroderma Network.

We welcome your photos of symptoms of scleroderma or related illnesses, such as autoimmune, arthritis, or skin disease symptoms. Please submit this permission form first, and then email your symptom photos to webmaster@sclero.org. (Sorry, the photos cannot be uploaded with this form.)

Your Full, Real Name: Your full, real name is required in order for you to donate photos to our ISN Photo Repository. However, you are given a choice below as to whether you will allow us to associate your name or nickname with the photos. See our Privacy Policy.
Your Email Address: This is required in order for us to be able to reply to you.
Alternate Email: We will use this address if email is returned from your first address, for any reason.
Subject:
I am donating digital files or originals of my photos to the nonprofit International Scleroderma Network (ISN). The photo(s) which I have submitted (or will be submitting) to the ISN Photo Repository have been created for use by the International Scleroderma Network, and represent my original work.
Please check only one box: You may associate my real name with the photo(s), if you want. You may associate only my nickname of with the photos, if you want. You may use my full real name or my nickname or both, if you want. Please do not associate either my real name or my nickname with these photo(s).
Please enter your comments about the photos or explanation(s) we may use on your photo page(s) here, so that we can accurately identify your illness, symptoms and photos. Your Description of Photo 1:
Your Description of Photo 2:
In order to help raise awareness of scleroderma or related illnesses or symptoms, I donate the photo(s) to the ISN for any use, such as for use on the website, in print materials, media, posters, books or videos (etc.), with no limitations. If you agree to this, fill in the following:
Your Full, Real Name:
Your Street Address, City, State, Country and Zip Code:
Your Home Phone:

Thank you for your donation to the ISN Photo Repository. Please email your symptom photo(s) to: webmaster@sclero.org It usually takes anywhere from one to thirty days for new photos to be posted. Please feel free to email our webmaster with any questions you may have.