I hereby consent to and authorize the Hydrocephalus Association (HA) and its representatives, successors, assigns, licensees, employees, and any person, corporation or entity acting under its permission or with its authority, including anyone distributing or disseminating communications by or regarding HA, the irrevocable right, permission, and license to publish, reproduce, distribute, and/or otherwise use my name and any still or moving image, likeness or sound recording of me.
I hereby waive all rights of inspection or approval with regard to any recording, taping, reproduction, proposed printed, audio or video publication, and/or other use of my name and the performance.
I hereby release, discharge, and agree to hold harmless HA from and against any and all liability to me or any third parties resulting from the use of my name and performance.
I agree that my participation herewith is voluntary and without compensation, and I assume complete responsibility for my actions in connection herewith.
Nothing herein shall constitute any obligation on the part of HA to make any use of any of the rights granted herein.
This authorization and release shall be binding upon my heirs, successors, assigns, and personal representatives, without regard to whether it is expressly acknowledged in any instrument of succession or assignment.
