AUTHORIZATION AND RELEASE CONSENT INFORMATION

I understand my photographs and/or videos will be submitted to RajaniMD (Hereinafter RajaniMD will be referred to as “THE COMPANY”)

My photos and videos may be used in connection with publicizing and promoting THE COMPANY. I authorize THE COMPANY to use my name, product use details and the before and after photographs and/or videos as defined in this form.

I understand by signing this form, my photographs and/or videos become the property of THE COMPANY.

I hereby irrevocably authorize THE COMPANY to copy, publish, or distribute the photographs and/or videos of me for purposes of publicizing programs of THE COMPANY or any other lawful purpose. Before and after photographs taken of me may be used in printed publications, mulitimedia presentations, on public websites and on any other form of public distribution media.

I agree that I will make no monetary or other claims against THE COMPANY for the use of photographs, videos, my name, or product use details.

In addition, I waive any right to inspect or approve the finished product, including written copy, wherein my photographs, my videos, and/or my likeness appear.

I HEREBY HOLD HARMLESS AND RELEASE THE COMPANY FROM ALL CLAIMS, DEMANDS, AND CAUSES OF ACTION WHICH, I, MY HEIRS, REPRESENTATIVES, EXECUTORS, ADMINISTRATORS, OR ANY OTHER PERSONS ACTING ON MY BEHALF OR ON BEHALF OF MY ESTATE HAVE OR MAY HAVE BY REASON THIS AUTHORIZATION.