Publicity Release Form

I grant Purdue Healthcare Advisors, the Regenstrief Center for Healthcare Engineering, and Purdue University and its agents and employees the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of me, or members of my family, for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium. I hereby release Purdue University and its legal representatives from all claims and liability relating to said images or video. Furthermore, I grant permission to use statements that I gave during an interview, training session, improvement event or other collaboration with Purdue, with or without my name, for the purpose of marketing, advertising and publicity without restriction. I waive my right to any compensation.