By checking the box and submitting the form “Share Your Success Story,” I give my permission to use my name, likeness, image, voice, and/or appearance as such may be embodied in any pictures, photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf of Synergy Lifestyle Medicine activities. I agree that Synergy Lifestyle Medicine has complete ownership of such pictures, etc., including the entire copyright, and may use them for any purpose consistent with the Synergy Lifestyle Medicine mission. These uses include, but are not limited to, illustrations, bulletins, exhibitions, videotapes, reprints, reproductions, publications, advertisements, and any promotional or educational materials in any medium now known or later developed, including the Internet. I acknowledge that I will not receive any compensation or reimbursement for the use of such pictures, etc., and hereby release Synergy Lifestyle Medicine and its agents and assigns from any and all claims which arise out of, are in any way connected with, such use.