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This License and Release shall serve as a license to use and a release regarding the use of my name, image, recordings, video likeness, written testimonials and photographs in connection with educational, promotional, or advocacy purposes. I, hereby irrevocably grant to the PHYSICIANS FOR FAIR COVERAGE, LTD ("PFC") and its designated representatives, agents, officers, directors, and employees (collectively with PFC referred to as the “Licensees”) permission to use, modify, reproduce, distribute, publish, summarize, excerpt or otherwise use, create derivative works of, publicly display and perform, in perpetuity and royalty-free, my name, image, recordings, video likeness, written testimonials, and photographs in connection with the educational, promotional, and advocacy materials of PFC, in any manner and in any medium, as PFC, in its sole discretion, shall deem appropriate or desirable. I hereby waive any right I may otherwise have to approve such use of my name, image, recordings, written testimonials, video likeness and photographs, and I release the Licensees from any claim or liability arising out of the use of my name, image, recordings, video likeness, written testimonials, and photographs.

The territory as to which this License and Release shall apply is worldwide and I acknowledge the receipt of good and valuable consideration for the rights granted herein. Nothing herein will constitute any obligation on PFC to make any use of any of the rights set forth herein.

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