The undersigned subject of stories, quotes, photographs, recordings, film, or other personal biographical information (collectively “Materials”) hereby grants to the National Board of Medication Therapy Management, Inc., a nonprofit service and advocacy organization located in Washington, DC, including its successors, sponsors, employees, distributors, licensees and assigns (collectively, the “Publisher”), the unrestricted permission, right and license to use the Materials and to reproduce, exhibit, broadcast, advertise and exploit all or any part of the Materials in any media chosen by the Publisher.

The undersigned consents to use of the Materials in any story, quote, photograph, biography, recording or other media produced by or on behalf of the Publisher. The undersigned is aware that the Materials may be published by the Publisher in print or in electronic publications such as on the Publisher’s website(s) and may be released to news media and others in connection with the promotion or publicizing of the activities of the Publisher, including advocacy activities. The undersigned understands that there will be no payment ever for the use of name, information and the likenesses.

The undersigned grants permission to use his/her name or likeness and biographical data in connection with publication of the Materials, and/or the use of his/her personal story or quote under a pseudonym.

The Publisher shall own any copyright and all other intellectual property rights in the Materials.
The undersigned waives any demand for compensation and waives any claim to any moral rights or any violation of rights to privacy, publicity or confidentiality under any statute or common law in connection with any use of the Materials.

The Publisher proposes to act in reliance on this Consent, therefore the undersigned declares it to be irrevocable, and releases the Publisher from any and all claims, liability, actions or demands whatsoever in connection with the use of the Materials as provided in this Consent.