I, the undersigned, grant to Miramar Labs, Inc. (“Company”) and its licensees, successors and assigns (collectively called the “Licensed Parties”) a worldwide, perpetual right and license to use, reproduce, print, publish, broadcast and rebroadcast, as well as to copyright, my first name and initial of last name, testimonial statement, including voice, picture, and likeness, (collectively referred to as “Testimonial”) in any and all media and types of advertising and promotion (collectively referred to as “Advertising”) for Company and its products and services.
Without limiting the foregoing, I hereby give permission to the Licensed Parties to use my Testimonial in whatever medium deemed appropriate by the Licensed Parties for any of the following purposes: (i) educational and research purposes, (ii) marketing and promotional purposes, (iii) collateral and promotional materials, and (iv) public and media relations (collectively referred to as “Authorized Purposes”). The Licensed Parties will not use my Testimonial for any other purposes.
I understand that use of my Testimonial may result in disclosure of my “individually identifiable health information” as defined by the Health Insurance Portability and Accountability Act (“HIPAA”), including without limitation information about my health condition. I also give consent to the use of such information by the Licensed Parties. My health information revealed to the Company will no longer be protected by Federal privacy regulations, including HIPAA.
I understand that I will not have any right to compensation in connection with the Licensed Parties’ use of my first name and initial of last name, testimonial statement, including voice, picture, or likeness. I hereby release the Licensed Parties and their successors and assigns from any and all claims arising out of their use of my Testimonial as agreed to in this document, including without limitation any claims based on the right of publicity or privacy. I hereby waive any right to review any use of my Testimonial as agreed to in this document and no such material need be submitted to me for any further approval.
The statements attributed to me in my Testimonial reflect my actual experience with Company and my honest opinions about Company and/or its products. I agree to notify Company in writing if the statements given no longer reflect my experience or opinions, in which case I understand that Company will, within a commercially reasonable time, stop using the testimonials for commercial purposes.
This Consent and Release does not in any way conflict with any existing commitment on my part. I have not previously authorized or permitted the use of, nor will I, during the two year period following the date I sign this Consent and Release, authorize or permit the use of, my name, picture, likeness or testimonial statement in connection with the advertising or promotion of any product or service that competes with or is incompatible with Company’s Products or Services.
