ACTHIV^® Institute has requested permission to use my name, biographical or occupational description, phrases regarding me (or incidents or anecdotes concerning me substantially as set forth in an attachment which is made a part of this release), portrait, picture, likeness, or voice or any or all of them, in a recording, video, television production or reproduction, sound track recording, still photograph, or an Internet website or otherwise.

I hereby grant to ACTHIV^® Institute, a Division of the American Academy of CME, Inc., its successors, assigns and anyone acting under its authority or permission the right to make originals where appropriate and to use for any lawful purpose (including publicity and other trade purposes) throughout the world and reproduce at any time in any form or manner and to copyright any of the items referred to in the preceding paragraph.

I hereby release ACTHIV^® Institute, a Division of the American Academy of CME, Inc., its successors and assigns of and from any claim which I might otherwise have as a result of any such use, copyright or publication.