| For consideration which I acknowledge, I grant to the Ohio State Medical Association (OSMA) the absolute and irrevocable right and unrestricted permission concerning any photographs/videos taken of me or in which I may be included with others, to use, reuse, publish, and republish the photographs/videos in whole or in part, individually or in connection with other material, in any and all media now or hereafter known, including the internet, and for any purpose whatsoever, specifically including illustration, promotion, art, editorial, advertising, and trade, without restriction as to alteration. I release and discharge OSMA from any and all claims and demands that may arise out of or in connection with the use of the photographs/videos, including without limitation any and all claims for libel or violation of any right of publicity or privacy.
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| This authorization and release shall also inure to the benefit of the heirs, legal representatives, licensees, and assigns of OSMA, as well as the person(s) who took the photographs/videos. I am a legally competent adult and have the right to contract in my own name. I have read this document and fully understand its contents. This release shall be binding upon me and my heirs, legal representatives, and assigns.
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