SUBMIT A STORY - NurseSpeak

First name *
*Stories are published anonymously*

Last name *

Email *

Topic *

Please select which topic fits best:

Title
The title of your story if you have one

Message *
Copy and paste your story here

Release Form *
By filling out this digital release form, I (Name Listed Below) hereby grant Nurselifern Inc permission to use the content submitted in their publication, including their website & internet postings. I verify that I own the rights to have this content distributed, published, or otherwise promoted by Nurselifern Inc as they see fit for their publication. I certify that this work is not plagiarized from another source.

I understand that content I submit to Nurselifern Inc may be used in their publication in print or digitally, as well as on their website and other social media and internet postings.

I understand that by completing this form not only allows Nurselifern Inc to use my content in their publication, and at no time will Nurselifern Inc assume rights to the content themselves, other than me allowing them the right to publish the content submitted.

I understand that at no time shall I be paid, reimbursed, compensated, given a free magazine, or given royalties, now or at any point in the future by Nurselifern Inc unless other wise stated by Nurselifern Inc.

I hereby irrevocably authorize Nurselifern Inc to copy, exhibit, publish or distribute this content in their publication for purposes of publicizing Nurselifern Inc in their publication, website or internet postings or for any other lawful purpose. I also give the right for Nurselifern Inc to make any necessary edits (i.e. grammatical or HIPAA related…..) to print their publication.

I hereby hold harmless and release and forever discharge Nurselifern Inc from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on the behalf of my estate have or may have by reason of this authorization.

I certify that the person or ALL patient(s) named in content provided (stories) have been altered in accordance with HIPAA. I understand that I have the option for my story/content to be published anonymously.

I understand that submissions of content, or completion of release, is not a guarantee of publication. If Work is published, it is the duty of the provider (and not Nurselifern Inc) to notify all involved parties of their involvement in the final product.

I have read this release and I fully understand the contents, meaning, and impact of this release.
I agree *