Undiagnosed Memorial

The UNDIAGNOSED documentary team and the Undiagnosed Diseases Network Foundation (UDNF) are working together to build memorials to those who passed away without a diagnosis. If you have a loved one you wish to pay tribute to, you can submit their name and photo. UNDIAGNOSED is creating a memorial webpage on this website. The UDNF will also be building a commemorative memorial.

Name of your deceased, undiagnosed loved one

First Name

Last Name

Please upload 1 single, high quality photo that ONLY features your loved one. This photo should be a closeup of their face, or at least not too far away from camera. If the photo is high quality enough, we will be able to zoom in on their face. Max Size 10 MB

FileField; MaxSize=10000KB; addText=Upload_A_Photo

Your Name

First Name

Last Name

Email

Optional Message

Agreement to MATERIALS RELEASE

"By checking this box, and by uploading these materials, I agree to be bound by the terms of the Materials Release as is displayed at the bottom of this webpage.”

MATERIALS RELEASE

For good and valuable consideration, the receipt of which is hereby acknowledged, I, the undersigned, irrevocably grant permission to Undiagnosed Films LLC, and the Undiagnosed Disease Network Foundation (UDNF), and their affiliates, licensees, employees, successors, and assigns (collectively, “Producer”) the non-exclusive right to photograph and reproduce all materials (e.g. photographs and footage) uploaded by me onto the www.UndiagnosedFilm.com website (the “Materials”) and in connection with the documentary film currently entitled Undiagnosed, and in connection with the UDNF Undiagnosed Memorial Project (collectively the “Project”) or any version thereof, and to distribute, exhibit and otherwise exploit (and to authorize others to distribute, exhibit and exploit) the Project and its related advertising, publicity and promotion (including without limitation “making of” and “behind the scenes” programs) incorporating the image of the Materials throughout the universe in perpetuity in all media and by all means, now known or hereafter developed.

I hereby represent and warrant that: (i) I have the sole right and authority, as the copyright owner of the Materials or the authorized agent of the owner, to grant the rights granted herein; (ii) the consent or permission of no other person or entity is necessary for me to enter into this release; and (iii) Producer’s use of the Materials as described herein will not violate the rights of any third party.

In no event shall I be entitled to seek to restrain the development, production, distribution, exhibition, marketing, advertising, or other exploitation of the Project or otherwise seek or obtain injunctive or other equitable relief. I hereby release and discharge Producer, its employees, agents, licensees, successors and assigns from any and all claims, demands or causes of action that I may have for libel, defamation, invasion of privacy or right of publicity, infringement of copyright or violation of any other right arising out of or relating to any of the rights granted herein.