I hereby grant to West Texas Rehabilitation Center, their agents, successors, assignees, and affiliates, and their respective employees, officers, directors, shareholders, and representatives (collectively “Producers”) the right and permission to film, photograph, and record me and to use my name, voice, image, information about me and any ideas or materials that I provide Producers (collectively, the “Materials”) in works created by Producers (the “Program”) and in connection with advertising, publicizing, broadcasting, producing, and exploiting the Program, in any and all media now known to hereafter developed, in perpetuity. I understand that Producers are under no obligation to incorporate my appearance at this event.

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