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By submitting this form I affirm that I am at least eighteen years of age, and I hereby grant irrevocable permission to BIOFLEX (the “Releasee”), its clients, licensees and assignees, to use my name and likeness and attached text of my testimonial in perpetuity, in whole or in part, in all manner of photographs, portraits, motion pictures and television, and on video-cassette, CD-ROM, CDi , DVD, Web format and all other present or future formats, and all reproductions thereof, in any form whatsoever, and, if applicable, to use, record, amplify, modify, mix and reproduce my voice, sounds and/or audio, instruments or sound effects in any manner whatsoever, in whole or in part, in perpetuity, for any advertising, publication, promotion, or any commercial, theatrical, educational, informational or any other purpose whatsoever.

I irrevocably release the Releasee from any and all liability from all such use.

I hereby waive any and all copyright, moral and all other related rights which may arise in relation to the use by the Releasee of my name, likeness, voice, sounds, and/or audio, instruments or sound effects in accordance with the foregoing, all of which shall belong to and are hereby assigned to the Releasee absolutely.