I am submitting a video, photographs, stories or other content (referred to as “Material”) which may be used by Access to Medical Imaging Coalition (“AMIC”) as follows:
I understand that AMIC and/or its agents may edit the Materials and use all or part of the Materials for any of the uses described above.
By signing below, I give my permission to AMIC and its partners and agents to use the Materials, including my name, likeness, personal story and voice without further compensation. It is my understanding that my signature below releases Access to Medical Imaging Coalition from any financial or legal responsibility for the use of the Materials. I confirm to AMIC that I own the Materials and have the right to grant AMIC the rights I am granting to it in this Release Form.