Terms and Conditions: I give permission to share my story publicly on the SummaCare website, social media platforms and print collateral materials. My story may be edited for content and grammar as decided by SummaCare's Marketing department. I further acknowledge any confidential medical information included and disclosed in my story will be public. I agree in order to assist scientific, treatment, educational, public relations and charitable goals and hereby waive any right to compensation for such uses if applicable. I hereby hold SummaCare and its subsidiaries harmless from and against any claim for injury or compensation resulting from the activities authorized by this consent.

Member Release: In consideration of my testimonial as a member of SummaCare and for other good and valuable consideration herein acknowledged as received, I hereby grant to SummaCare, Inc., its legal representatives and assigns, those acting on behalf of SummaCare, Inc. and those acting with its authority and permission, the irrevocable and unrestricted right and permission to copyright, in its own name or otherwise, and use, reuse, publish and republish photographic portraits, pictures or video of me or that in which I may be included, in whole or in part or composite or distorted in character or form, without restrictions as to changes or alteration, in conjunction with my own or fictitious name, or elsewhere, and in any and all media now or hereafter known for illustration, promotion, art, editorial, advertising, social media, trade or any other purpose whatsoever. I also consent to the use of any printed matter in conjunction therewith. I hereby waive any right that I may have to inspect or approve the finished product or products and the advertising copy or other matter that may be used in connection therewith or the use to which it may be applied. I further acknowledge that by permitting SummaCare and its designees to use and disseminate these photographs, audio and video, certain confidential medical information may be included and I hereby consent to the disclosure of this information. I hereby waive all copyright claims or claims based in rights of publicity or privacy related to my appearance in the photograph, audio or video. I hereby release, discharge and agree to save harmless, SummaCare, Inc., Its legal representatives and assigns, and all persons acting on behalf of SummaCare, Inc. from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of said picture or video or in any subsequent processing thereof, as well as any publication thereof, including without any limitation, any claims for libel or invasion of privacy. I hereby warrant that I am of full age and have the right to contract in my own name. I have read the above authorization, release and agreement, prior to its execution, and I am familiar with the contents thereof. This release shall be binding upon me and my heirs, legal representatives and assigns.