Thank you for taking the time to share your testimonial and photos! We truly appreciate it. Please set aside 10-15 minutes of your time for full completion. We are sure that your story will inspire thousands of others to get out of pain and get back to doing what they love. Thank you, again!     

                                                                                          -Dr. Mike

WAIVER AND RELEASE

I,      {name}     , grant to MoveU Holdings Inc., including its authorized employees, agents and representatives, and its affiliates (collectively, “MoveU”), the perpetual and irrevocable right and permission to use and publicly display my name, likeness, voice, words (audible or written) and/or property (individually or collectively, my “Likeness”) alone or with those of others, by means of photographs, video, images, audio recording, and/or written statements taken or made of my Likeness in any format or media, and to adapt, modify, reproduce, distribute, publicly perform, display and/or copyright such photographs, video, images, audio recording, and/or written statements, in whole or in part, individually or in conjunction with other materials, in any media now known or later developed, and for use in any commercial or lawful business purpose related to MoveU, including, without limitation, in advertising, promotional, public relations, educational and fundraising materials.

I agree that the photographs, video, images, audio recording, written statements and likeness become the property of MoveU, and may not be returned to me. I understand that I will not have any rights of ownership to such photographs, video, images, audio recording, written statements and likeness. I also understand that MoveU shall own all rights to such photographs, video, images, audio recording, written statements and likeness, and I waive any right to inspect or approve their use by MoveU. I understand that my Likeness may not necessarily be used by virtue of this agreement.

I waive the right to receive any payment for signing this waiver and release (“Release”). I also waive the right to receive any royalties or other compensation in connection with MoveU’s use of my Likeness for any of the purposes authorized by this Release.

I hereby release, waive, and discharge MoveU, its successors and assigns, from any and all demands or claims that I have or may have arising out of or in connection with the use of my Likeness, as described above, or such photographs, video, images, audio recording and/or written statements, including, but not limited to, any claims for invasion of privacy, defamation, infringement of the right of publicity, or any other causes of action arising out of the use, adaptation, reproduction, distribution, broadcast, or exhibition thereof. I further waive all moral rights to the extent possible.

I declare that: (1) I am of legal age and I have every right to contract in my own name, or my parent or legal guardian has signed below; (2) I have every right to grant MoveU the use of my Likeness without violating other commitments.

I understand and agree that this Release is binding and constitutes an agreement between myself and MoveU, and no waiver, modification or addition to this Release shall be valid unless in writing and signed by the parties. I have read this Release and I fully understand its contents, meaning, and impact.

Media Usage and Release Agreement

By signing below, and for good and valuable consideration, the receipt of which is hereby acknowledged, I hereby do assign to insert company name, its parent, subsidiaries, affiliates, legal representatives, successors and assigns (collectively, “Company”), all rights, title and interest in and to any and all photographs, video, and audio recordings of me taken or recorded as part of Company’s advertising and marketing efforts (collectively, “Media”).

To the extent required, I further consent and authorize, Company and its third-party licensees, to use, publish, display, broadcast and reproduce the Media (without any additional consideration owed to me), for any purpose and in any manner or medium, including, but not limited to advertising, marketing, and other public and/or social media as may be deemed appropriate by Company or its third-party licensees. I understand that I may be identifiable from the Media, and also hereby waive any right to inspect or approve any finished photographs, video, or other electronic matter, that include all or some of the Media, and that may be used by Company (or its third-party licensees) now or in the future, and no matter whether that use is known to me or unknown.

I further agree to release and forever discharge Company (and its third-party licensees) from any and all claims in law or equity that I, my heirs, executors, personal representatives, or assigns have or may have arising out of, or relating to, the Media including, but not limited to, claims relating to invasion of privacy, infringement of moral rights, rights of publicity or copyright.

I further understand and agree that all rights under Section 1542 of the Civil Code of California (“Section 1542”) and any similar law of any state or territory of the United States that may be applicable with respect to the foregoing release are hereby expressly and forever waived. To this end, I acknowledge that Section 1542 provides that: “A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR OR RELEASING PARTY DOES NOT KNOW OR SUSPECT TO EXIST IN HIS OR HER FAVOR AT THE TIME OF EXECUTING THE RELEASE AND THAT, IF KNOWN BY HIM OR HER, WOULD HAVE MATERIALLY AFFECTED HIS OR HER SETTLEMENT WITH THE DEBTOR OR RELEASED PARTY.”

The terms of this agreement are governed in accordance with the laws of the State of California, and any legal disputes concerning the terms herein shall be handled through binding arbitration.

I HAVE READ THE RELEASES CONTAINED HEREIN AND FULLY UNDERSTAND ALL OF ITS TERMS. I HAVE EXECUTED THIS AGREEMENT VOLUNTARILY AND WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE.