Form

Thank you for participating in your local 40 Days for Life vigil!

We love to share the fruits of the campaign to encourage vigil participants around the world. Please use this form to report what the Lord has done at your location!
Name

First NameLast Name
Vigil Location (City,State/Province/Country)
Type
- Number
- Date
  
  MonthDayYear
  Date
- Number
- Date
  
  MonthDayYear
  Date
- Did the worker show signs of conversion?
- Facility name
- What happened?
- Photo/Video Upload
  
  Cancelof
- May we publish the information you submitted?
- IP MEDIA USE AGREEMENT
  
  Thank you for allowing 40 Days for Life (“40DFL”) to use your name, story, photos, and/or videos (“IP”) for use in 40DFL's various media in furtherance of our Mission ("Purpose").
  
  This Agreement constitutes a current, non-exclusive, royalty-free assignment of any ownership rights that you may have in law or otherwise for the Purpose:
  
  YOU grant and assign to 40DFL all right, title, and interest in and to the IP, and all literary property therein, including all copyrights as well as all renewals and extensions of copyright throughout the world, now or hereafter provided. 40DFL’s rights will thus include, but not be limited to, the exclusive right to publish, adapt, license, copy, transmit, translate, republish, distribute, and sell the IP in whole or in part in any channels and by any method or means currently available or developed in the future. The copyright of use for the Purpose shall be in the name of 40DFL or its designee.
  
  Please sign and date below to confirm your permission for 40DFL to use the IP under the conditions of this Agreement, without further notice, permission, royalties and/or compensation to you.
  
  You confirm that you have all rights to the IP and are not infringing on any third-party rights connection with the IP.
  
  You may revoke this permission at any time in writing. Such revocation will be effective from the date of your revocation forward but shall not affect or limit uses then in effect.
  
  Thank you.
- NAME
  
  First NameLast Name
- NAME OF PARENT/GUARDIAN IF A MINOR
  
  First NameLast Name
- SIGNATURE
- DATE
  
  MonthDayYear
  Date
Should be Empty: