I hereby grant permission and authorize Neuro-Empowerment, LLC, and all of its assignees and licensees (collectively “The Entity”) to edit, alter, copy, exhibit, publish, distribute, and make use of my likeness, any and all video, and/or photographs I voluntarily submit for The Entity’s expressed use, as well as any voluntarily submitted recordings of my voice and/or any of my voluntarily submitted written or transcribed statements for any lawful purpose.
This authorization and release shall NOT extend to any other likeness, video, photographs, recordings of my voice, statements, or use of my name which I have not voluntarily submitted to The Entity, regardless of medium and regardless of public availability.
I further understand and expressly grant The Entity authorization to use any voluntarily submitted likeness, images, videos, recordings of my voice, statements, as well as my name, in the following manner:
Use in any reproduction, distribution, derivative works, display, and/or performance as The Entity shall solely determine;
Use in any composite or modified forms and in any media, now known or later developed, including without limitation newspapers, television, radio, the World Wide Web, and/or social media;
Use for any purpose, in any language, throughout the world including, without limitation, for the purpose of education, advertising, and promotion; and
This authorization and release shall continue in perpetuity, but only as to items I voluntarily submit, unless I otherwise revoke this authorization in writing.
I further acknowledge that I will not be compensated for any of these uses, and I further waive any right to royalties or other compensation arising or related to any use. Additionally, I agree that The Entity shall exclusively own all rights to the images, videos, recordings, or written works I voluntarily submit to them, as well as any derivative works created from them.
I waive the right to inspect or approve of the uses of any printed or electronic copy.
I hereby release The Entity, its board, members, officers, employees, advisors, its assigns, and licensees from any and all claims that may arise from these uses, including without limitation to claims of defamation or invasion of privacy, infringement of moral rights, rights of publicity or copyright.
This Release is binding on me, my heirs, assigns, and estate. The Entity is not obligated to use any of the rights granted under this Release. This Release expresses the complete understanding of the parties.
