I hereby consent to the Chiro One Wellness Center entities, TVG-Medulla, LLC (its marketing services
provider), and their affiliated companies, doctors, and employees (collectively “Chiro One”)
recording, videotaping, audiotaping, photographing, editing, modifying, copying, or otherwise
reproducing “My Chiropractic Success Story.”
I grant to Chiro One the right to use my voice, likeness, first name and last name initial, and the
content of “My Chiropractic Success Story,” as edited by Chiro One in its sole discretion, in connection
with promoting Chiro One’s chiropractic care and other marketing purposes, and I release any expectation
of privacy or confidentiality of “My Chiropractic Success Story” and any expectation of ownership
or compensation from Chiro One.
I further grant to Chiro One and its assignees and licensees a perpetual, royalty-free, worldwide license
for the limited purposes above in any medium, including, without limitation, print, television
(including broadcast, cable, and satellite), electronic (including the internet and intranet),
and any other communications media currently existing or later created.
I represent that:
- I am over the age of 18 years;
- I have authority to grant consent as provided herein on behalf of myself, my heirs, representative,
and assigns; and
- my “Chiropractic Success Story” submitted to Chiro One was true.