Standard Clearance Agreement and Release

1. For good and valuable consideration, receipt of which is hereby acknowledged, this Agreement shall confirm that I grant permission to Saint Luke's Health System, and its affiliates, distributors, licensees and assigns (collectively, “Producer”), to use, release, exhibit, depict, display, reproduce and broadcast the Material, as well as for ancillary, subsidiary and related commercial purposes (including, without limitation, all advertising, publicizing, promotion, merchandising, exhibiting and exploitation), by any and all media, technology and devices in perpetuity throughout the universe, at no charge to Producer. It is agreed that no payments, residuals, reuse fees or other compensation shall be made to me or any other party in connection with the use of the Material.

2. I represent and warrant that the Material was created and/or is owned by me and that the Material is original; that I am the sole owner of all rights in and to the Material; that I have obtained all rights, consents and permissions necessary regarding the content of the Material and the Material (including, but not limited to, rights of any party appearing in the Material); that I have the full right, power, authority and ability to enter into and fully perform this Agreement, including granting the rights herein; that no other party’s consent is necessary to effectuate the full and complete exercise of the rights granted herein; that I have not entered into any other agreement which would in any way prevent me from performing this Agreement; that I have not done anything (nor do I plan on doing anything) which would prevent or interfere with the full and complete performance hereto or exercise of the rights granted herein; that any use of same hereunder does not violate the rights of any party; and that the Material is not the subject of any litigation. I further agree that I shall not, and hereby waive any right to, terminate these authorizations or obtain injunctive or other equitable relief with respect to this Agreement and/or the Material. I will indemnify and hold harmless Producer and its parents, subsidiaries, affiliated entities, successors, licensees, employees, agents and assigns from and against any and all claims, demands, liabilities, damages, costs and expenses (including, but not limited to, reasonable attorney’s fees) arising out of or related to the breach, actual, anticipatory or alleged, of the foregoing warranties, representations and this Agreement.

3. I hereby release Producer from any claims, whether existing at present or in the future, including, without limitation, all rights, demands and/or liabilities regarding invasion of privacy, right of publicity, defamation (including libel and slander), copyright infringement, moral rights, confidentiality, and/or any other personal or property interests or rights, or any cause of action or claim arising out of production, distribution, broadcast, exploitation or exhibition of the Material and any ancillary and subsidiary uses of the Material. I shall not now or in the future assert or maintain any such claim against Producer.

Electronic submission of this form signifies that I have read and understand the Standard Clearance Agreement and Release form and that my questions have been answered to my satisfaction.