I hereby grant to the Alzheimer’s Foundation of America, Inc. (the “Foundation”) the absolute and irrevocable right and unrestricted permission to use and/or reproduce my (and/or my child’s or children’s) name, likeness, image, voice, and/or appearance as such may be embodied in any photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf of the Foundation. I agree that the Foundation has complete ownership of such material and can use said material for any purpose consistent with the Foundation’s mission. These uses include, but are not limited to, videos, publications, advertisements, news releases, Web sites, and any promotional or educational materials in any medium. I acknowledge that I will not receive any compensation for the use of such images, video, likeness, etc.

I hereby release and discharge the Foundation, and its agents, representatives and assignees from any and all claims and demands arising out of or in connection with the use of my name, likeness, image, voice and/or appearance, including any and all claims for invasion of privacy, right of publicity, misappropriation or misuse of image, and/or defamation.

I represent that I am over the age of eighteen (18) years (or I am the parent or legal guardian of one or more children to whom this release applies) and that I have read the foregoing and fully understand its contents. This release shall be binding upon me, my heirs, legal representatives, and assigns.

This release is being made and entered into under the laws of the State of New York and shall be governed and interpreted in accordance with the laws of said state. This agreement embodies the entire agreement of the parties.