In consideration of my participation in a video conference entitled:
Intensive Update with Board Review in Geriatric and Palliative Medicine

I, the undersigned, hereby grant and release to Ebix, Inc., DBA Oakstone Publishing, its successors, assigns, licensees, affiliates, employees and agents (collectively, “CMEinfo”) the right to digitally record and/or transcribe my entire presentation, including my likeness, voice, and verbal statements, and to edit, at the discretion of CMEinfo, such digital video/audio recording to incorporate into multimedia programs and course materials and to market and sell the same.

I authorize CMEinfo to reproduce, distribute, exhibit, and otherwise use or authorize the use of such program and materials or any portion thereof by any means including by distribution via the Internet, video DVD, audio CD, broadcast over television, radio, cable, or any other electronic media, or in any other media now known or later developed. I retain all copyright and other rights in the materials produced/provided by me and may use material as required in my own educational endeavors. I will receive a complimentary copy of the video of my presentation(s) provided I list my address below. I understand and agree that this is the entire consideration and compensation due to me for the use, reproduction or distribution of such video/audio program by CMEinfo.

I further grant to CMEinfo the right to use my name, likeness, voice, brief sample clips of my lecture(s), and biographical and other information concerning me solely in connection therewith, including for the marketing and promotion of the program, but not in any testimonial or endorsement manner.

Further, I hereby grant CMEinfo the right to reproduce any materials produced or submitted by me for the conference for incorporation into a course syllabus for the conference and/or to accompany the recording or program.

I attest that the materials submitted to Oakstone/Ebix will not include any protected health information, as defined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended, unless I have obtained any necessary authorization, consent or release, or I have concealed personally identifiable information that may be protected by federal, state or local laws.

To the best of my knowledge any written material, slides or other data used in my presentation which is the subject of any property, intellectual property or other rights of any third party, will be cited with the necessary bibliographic information and submitted to CMEinfo within my PowerPoint slides.

Please Note: The name, accreditations, titles and affiliations submitted by you will be used in the course materials and program marketing. We will not publish your contact information.