Individual Release and Waiver of Rights for Learning Impact 2012
For good and valuable consideration received, I hereby irrevocably grant IMS GLC and those acting with its authority (collectively referred to as “IMS GLC”) the following:

1. All rights to use my name, voice, likeness, biographical information or image (the “Speaker Information”);
2. All rights to photograph me for promotional purposes (the “Materials”);
3. All rights to audiotape, videotape, or otherwise record me in an interview or participating in a session during [insert conference] (the “Materials”);
4. The unrestricted, absolute, perpetual, worldwide right (but not the obligation) to use, copy, modify, edit, create derivative works, display, transmit, perform, distribute, publish, exhibit and otherwise use the Materials in any and all media or form of
communication, whether now existing or hereafter developed, including on IMS GLC’s Web sites or those Web sites owned by IMS GLC affiliates or anyone acting with IMS GLC’s authority (the “Web Sites”), all for the purpose of publicizing IMS GLC's
programs (the “Purpose”).

I waive any right to royalties or other compensation arising from or related to the use of the Materials.

I acknowledge IMS GLC’s right to crop, splice, treat and edit the Materials at its sole discretion. I waive my right to inspect or approve the finished product, now and in the future, whether that use is known or unknown to me. IMS GLC reserves the right to discontinue
the use of the Materials without notice to me.

I represent and warrant that I have full power and authority to execute this Individual Release and Waiver of Rights (the “Release”). I hereby waive all rights and release IMS GLC from any claim or cause of action, whether now known or unknown, for defamation, invasion of right to privacy, publicity or personality or any similar matter, or based upon or relating to the use and exploitation of the Materials as contemplated herein, including but not limited to any reuse, distortion, blurring, alteration, optical illusion, or use in composite form, either intentionally or
otherwise, that may occur or be produced in production of the finished product.

I have read this Release before registering, and I fully understand the contents, meaning,
and impact of this Release.