I authorize the Service Employees International Union (SEIU), and its locals and affiliates, to publish the information I have provided, including my name, photograph, statement, video and any other information, in any forum including the internet and email. I confirm that the information provided does not contain any protected health information or any other information the disclosure of which would violate federal, state, or local laws. I understand that SEIU may edit the information I have provided if it deems it appropriate. I hereby release SEIU from any liability and claims that I may have arising out of the use and publication of this material.  I confirm that I am at least 18 years of age and that all information in the material I have provided to SEIU is true and accurate to the best of my knowledge.