I, blanks*, do hereby authorize the Nebraska Society of Radiologic Technologists (NSRT) to use and disclose my interview, photograph, image, likeness, name, and/or audio/video recording that was made by or on my behalf of the NSRT or any of its affiliates without any fee or compensation of any kind for the purpose of promotional and/or educational use by the NSRT and/or its affiliates, including disclosures to the media and distribution to the general public for promotional and/or educational activities. Such disclosures may include release to radio, television, and newspapers, as well as other social media, which have their own editorial protocols, privacy policies, and information security – all of which are beyond the control of the NSRT. I release and relinquish to the Nebraska Society of Radiologic Technologists, any and all rights I may have in the use of such photograph, image, likeness, name and/or audio recording, or any promotional material derived therefrom. I acknowledge that nothing in this release obligates the NSRT or any of its affiliates in any way to make use of my photograph, image, likeness, name, and/or audio recording and that the NSRT will have the final authority concerning the content, use, and distribution of the promotional and/or educational materials derived therefrom.