=Release= For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby consent to the photographing of myself and the recording of my voice and the use of these photographs and/or recordings singularly or in conjunction with other purposes. I understand that the term “photograph” as use herein encompases both still photographs and the motion picture footage.

I further consent to the reproduction and/or authorization by Replimat LLC to reproduce and use said photographs and recordings of my voice, for use in diverse educational settings including online videos. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording.

I grant permission for this video to be uploaded to Replimat's public YouTube account or other public online video repository (initial one of the following options):

* _ immediately * _ after this date: * _ never (for internal use only)

This release applies to photographic, audio or video recordings collected as part of the sessions listed on this document only.

By signing this form I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes.

=Recording session name and date= * Full name: _ * Email: _ * Signature: _ * Date: If this release is obtained from a presenter under the age of 19, then the signature of that presenter's parent or legal guardian is also required. * Parent's signature: * Date: ___