I hereby authorize LetsStopAIDS to collect, use and disclose my image, likeness and the sound of my voice, as recorded by photograph or by audio or video tape, for the following purposes:

• Event presentations
• Educational presentations                   
• Informational presentations
• Online presentations       
• Online and print publications
• Educational videos     

By signing this authorization and release, I consent to photographic, audio and video recordings of me being electronically displayed via the Internet or in the public educational setting for the above-mentioned purposes. 

I understand that these materials may directly or indirectly reveal sensitive personal information about myself, including, for example, information about my health status. I also understand that there may be risks associated with this information being disseminated in the manner proposed, including, for example, the risk of discrimination, and online exposure, among others.

I understand that my image, likeness and the sound of my voice may be edited, exhibited, published or distributed for the above-mentioned purposes, and waive the right to inspect or approve the finished product wherein my image, likeness or the sound of my voice appears. 

I waive any right to any payment, royalties or other compensation or consideration arising from or related to the use of my image or recording by LetsStopAIDS for the purposes described above.

I also hereby release any and all claims against LetsStopAIDS utilizing this material for the purposes described above.

I acknowledge that there is no time limit on the validity of this authorization and release nor are there any geographic limitations on where the above-mentioned materials may be distributed. 

I understand that I am not required to sign this authorization and release and that, prior to signing, I am free to address any specific questions in writing to info@letsstopaids.org. By signing this form, I acknowledge that I understand the meaning, impact and risk of providing my authorization and release, and I warrant that my consent is freely and voluntarily given.

I understand that I may withdraw my consent to the above-mentioned use and disclosure of my image, likeness and sound of my voice at any time, subject to legal or contractual restrictions and reasonable notice, by emailing info@letsstopaids.org. I acknowledge that doing so will not grant me the ability to seek compensation or consideration for LetsStopAIDS’ prior use of my image or recording based upon my consent in this authorization and release. 

I am 18 years of age or older and am competent to contract in my own name insofar as the above matters are concerned.