CONSENT TO USE OF NAME, LIKENESS, IMAGE, ENDORSEMENT AND RELATED RIGHTS
For valuable consideration, including, without limitation, my involvement or continued involvement with the services and activities with Circle Surrogacy provided by Circle Fertility LLC, a North Star Fertility Partners LLC (“Company”), the receipt and sufficiency of which are hereby acknowledged, I hereby irrevocably grant to Company and its assigns and licensees an absolute, unrestricted right and permission throughout the world to use certain information that I provide to it, including my name, likeness, image, and oral and written statements, and all variations of the foregoing (collectively, “Likeness”), in connection with Company marketing activities (the “Purpose”) on websites, videotape, film, digital video, slides, photographs, digital images, CD-Rom, DVD, Blu-Ray, or any other media now known or later developed and utilized by Company (“Media”). To the extent I voluntarily provide my child’s Likeness to Company, I hereby consent to the publication and use of my child’s Likeness in any Media for the Purposes. This grant includes, without limitation, the right to use, reproduce, publish, exhibit, and distribute, over the Internet or otherwise, any Media containing my Likeness or as applicable, my child’s Likeness, in connection with the Purpose. This grant shall also include, without limitation, the right to produce, change, edit or alter, from time to time, any Media in which my Likeness or as applicable, my child’s Likeness, is included, individually or with others, for use in connection with the Purpose.
I hereby waive any and all right which I may have to inspect or approve the finished Media that may be produced in connection with the rights granted hereby or the use to which such Media may be applied. I hereby release, discharge and agree to defend and hold harmless Company, Company’s legal representatives, licensees and assigns, and all parties acting under Company’s permission or with authority from Company, from and against any liability of whatsoever kind, including, without limitation, liability for invasion of any personal property or privacy right, copyright infringement, and liability by reason of any distortion, alteration, blurring, optical illusion, changes or use in composite or other form, whether intentional or not, which may occur or be produced in the making of Media authorized hereby, or in any processing thereof, as well as any publication thereof, irrespective of the effect or consequences resulting therefrom.
I agree that all Media using my Likeness or as applicable, my child’s Likeness, produced by Company or any of the other parties granted rights hereunder shall be owned by Company and that Company shall be entitled to all rights, including without limitation the copyright, therein. If I should receive or obtain any print, negative or other copy of any such Media, I shall not authorize its use or reproduction by anyone else.
Nothing contained herein shall create any obligation on the part of Company to make any use of the rights granted herein.
I hereby warrant that I have read this Consent and the terms hereof prior to its execution, and that I am fully familiar with and understand the contents hereof. I represent that I am over eighteen years of age and agree that this Release is a legally binding agreement and will be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. Any provisions found to be void or unenforceable shall be modified to the minimum extent necessary to make them enforceable, or if such modification is not possible, then severed from this agreement, and shall not affect the validity or enforceability of any other provisions.
To the extent I provide Company with the Likeness of any other individuals, I represent and warrant that I have permission from such individuals to provide such Likeness and have all rights and permissions to grant Company a license and waiver to such Likeness in accordance with the terms and conditions contained herein.
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