AUTHORIZATION AND RELEASEAuthorization and Release • June 15th, 2020
Contract Type FiledJune 15th, 2020Purpose of Authorization and Release. By signing this authorization and release form (the “Authorization and Release”), I, , hereby grant to Next Door Neighbors, LLC, its subsidiaries, agents, licensees, successors and assigns, including Ascension Complete (“Ascension Complete”), the right to use (i) my name (in whole or in part), voice and appearance; and (ii) audio/visual recordings, verbal recordings, written statements, pictures, portraits, photographs, and any other image or likeness of me; (iii) biographical or occupational descriptions or phrases regarding me; and (iv) incidents or anecdotes concerning me and my experience with Ascension Complete (the “Material”) in any and all manner and media now known or later developed and for all types of advertising, publicity, promotion and other trade purposes, now and for any future use, throughout the world in perpetuity. I understand that any of my protected health information that is disclosed pursuant to this Authorization and Relea