TESTIMONIAL WAIVER AND RELEASE
I am at least eighteen (18) years of age, and I have the full right and authority to enter into this
I authorize the Pennsylvania Medical Society (PAMED), including an employee, agent, or independent contractor acting on behalf of the PAMED, to:
a. Use my testimonial (Testimonial);
b. Use, copy, distribute, perform, display, adapt, publish, create derivatives works of and transmit all or a portion of the testimonial and any derivative works in any format or medium (including but not limited to, print or electronic publications, multi-media productions, print or electronic communications, and Web sites) for PAMED purposes, including, but not limited to, recruitment and retention of members (Permitted Uses);
c. Reveal my name and identity in descriptive text or commentary in connection with any Permitted Use of the testimonial and any derivative works.
I made and provided the Testimonial freely and was not compensated in any way for making or providing it, and the Testimonial is true.
I warrant that any information provided in the Testimonial does not violate any right of, or breach any contract with, any person or entity.
I understand and agree that the Testimonial provided and any derivative works will belong exclusively to PAMED and that I am not entitled to any fees, royalties, or other compensation for any Permitted Use of the Testimonial or any derivative works.
I release PAMED and its officers and directors, members, employees, agents, affiliates, assignees and independent contractors from any and all liability that may or could arise from the acts that I have authorized herein, including but not limited to liability for invasion of privacy. I agree that I shall not may any claims or authorize the making of any claims against PAMED related to its Permitted Use of the testimonial. I waive any claim against PAMED for its use of the Testimonial.
THIS AGREEMENT PROVIDES PAMED WITH MY ABSOLUTE AND UNCONDITIONAL CONSENT, WAIVER, AND RELEASE OF LIABIITY, ALLOWING COMPANY TO USE MY TESTIMONIAL AS PROVIDED.