By signing this Release, I, hereby grant the Center for BrainHealth at The University of Texas at Dallas (Center) and the Brain Performance Institute at Center for BrainHealth (Institute) the right and permission to use, reuse, publish and republish (collective “Use”), without limitation all information provided by me and/or all photographs, motion picture, tapes, or other images of me resulting from interviews conducted with me by the staff of the Center and Institute (collectively “Information”) and my name for Use by the Center and Institute, including but not limited to, publicity and advertising on or in the Center’s and Institute‘s websites, social media sites and other media.

I acknowledge and agree that I shall have no copyright or other property interest in any works produced pursuant to the rights granted in the Release. I hereby release all of my rights, title and interests in and to all Information, including but not limited to, negatives, prints, tapes and reproductions thereof, and I do hereby release the Center, the Institute, The University of Texas at Dallas and The University of Texas System and each of their successors and assigns, if any, from any and all rights, claims, demands, actions or suits which I may or can have against them on account of the use or publication of my Information or my name.

I understand and agree that this Release is voluntary that may be revoked at any time by presenting a signed and written revocation to the Center and Institute. However, I understand and agree that such revocation shall only apply to future Use including republication or reuse of such Information.

By signing this Release, I signify that I am eighteen (18) or older, of sound mind, and otherwise legally competent to execute this release. I also signify that I have read and understand the terms of this release stated above and do hereby agree to its terms and conditions.