2026 Nano-rare Patient Colloquium Registration

For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby authorize n-Lorem Foundation (“n-Lorem”), its legal representatives, successors and assigns (collectively, “Authorized Parties”), and their officers, agents, and employees to photograph, film, or record me. I understand that any photograph, sound recording, motion picture, or video (the “Images/Video”) taken of me under this Authorization may be used to represent information related to n-Lorem’s activities, programs, and initiatives, including the Nano-rare Patient Colloquium (NRPC). I further acknowledge and agree that n-Lorem may share such Images/Video with third parties, for use consistent with the rights granted herein. I hereby assign to the Authorized Parties all rights, title and interest, including copyright, in and to any and all such photographs, sound recordings, motion pictures, or videos, and I hereby grant to the Authorized Parties, their officers, agents, and employees, the irrevocable right, license and permission to reproduce, copy, sell, exhibit, publish or distribute any and all Images/Video in any format, including on the Internet, whether composite, distorted, blurred or otherwise altered in character or form (intentional or otherwise), in conjunction with my name, information about me, and/or the names of any of the Authorized Parties, in any format, throughout the world, in perpetuity for the purpose stated above or any other lawful purpose whatsoever. In addition, if I provide to an Authorized Party any photographs, images or videos that I have taken, I hereby grant to the Authorized Parties a royalty-free, perpetual, irrevocable, sublicensable non-exclusive license to use such photographs, images and videos in the United States and elsewhere for any and all purposes. I also permit the use of any printed material in connection therewith, in written, electronic or any other form. I represent and warrant that (a) no other party has been granted an exclusive license with respect to the Images/Video, and (b) no other party’s authorization or consent is required with respect to the permission granted to the Authorized Parties under this Authorization. I hereby waive and relinquish any right that I may have to examine or approve the Images/Video, or the completed product or products or printed matter that may be used in conjunction therewith or the use to which it may be applied. I hereby release the Authorized Parties (and all persons acting under their permission or authority) from all claims, demands and causes of action arising out of or in connection with the use of the Images/Video, including but not limited to any and all claims for invasion of privacy, defamation, or infringement of copyright.