Permission and Release for Video/Audio Broadcast, Publication and Distribution Rights
I hereby authorize and grant permission for the Healthcare Innovation and Technology Lab, Inc. (“HITLAB”) to duplicate and record my presentation, written hand outs, slides and/or comments (the “Material”), in any and all forms, for the above-named event and/or publication. This permission includes any written materials authored by me as well as the rights of my image, likeness and sound of my voice as recorded on audio or video tape without payment or any other consideration.
I further grant permission for HITLAB to transcribe and reproduce this Material as part of any HITLAB digital library, and to distribute the Material in complete or partial form, and/or to edit, remix or alter same as part of any HITLAB commercial, educational or research presentation on CD-ROM, videocassette, broadcast, webcast, cablecast, laserdisc, multimedia or any other media format now or hereafter known. Further, I grant permission for HITLAB to distribute or sell the material in any form including video/audio recordings and/or written transcripts, in complete or partial form, and in translation, on videocassette, broadcast, cablecast, CDROM, laser disc, multimedia, print, electronic text, and any other media format now or hereafter known without payment or any other consideration.
These permissions also include rights for HITLAB to use my name, and any biographical material submitted by me, in connection with the Event/Publication named above, whether used in excerpts or in full, for the reproduction and distribution described above and for any associated marketing or exhibition.
I understand that HITLAB, as a research organization with broad educational purpose and its agents will invest considerable resources in reliance on the permissions and releases herein, and that HITLAB is under no obligation to exercise any or all of the rights, licenses, and privileges herein granted.
I hereby release and discharge HITLAB and the Event/Publication sponsors and organizers from any and all liability arising out of my participation in the Event. All permissions and releases granted by me herein shall be effective in perpetuity and extend and apply to HITLAB and its assigns, contractors, sublicensed distributors, successors, and agents. There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.
By signing this form I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. This consent and release shall also bind any and all of my heirs, successors and assigns.