RELEASE AGREEMENT: By registering for this event, all attendees listed on this form give consent to the Acoustic Neuroma Association (ANA) and UC San Diego Health, its affiliates and agents, to use all attendees’ images and likenesses and/or any interview statements from all attendees listed on this form in ANA publications or other media activities. This consent includes, but is not limited to:

• Permission to interview, record, photograph or otherwise make a video reproduction of attendees and/or the voices of all attendees listed on this form;
• Permission to use attendee's name and the names of all attendees listed on this form; and
• Permission to use quotes from interviews or excerpts of such quotes, recording, photographs or reproductions of all attendees listed on this form, in part or in whole, in ANA publications, newsletters, and other print media, and electronic media, including the internet, and/or in mailings for education.