Consent Statement
Thank you for submitting an application to become a Participant in the National Multiple Sclerosis Society’s Everyday Matters Program, sponsored by Genzyme Corporation.
In consideration of the review of my application by the Society and/or Genzyme, I hereby agree to the following terms and conditions
Authorization for Use and Disclosure of My Information
I hereby give the Society, Genzyme, and their affiliates and agents permission and the nonexclusive, perpetual right and license to review, disclose, use, reuse, publish, broadcast, display, modify, copy and distribute for internal or external communication, including in any and all media publication or forms, my name, voice, likeness, image, story, multiple sclerosis diagnosis date, my connection and experience with multiple sclerosis (including symptomology, medications, treatments, relationships with care providers), disease and other personal health information about me (relating directly and indirectly to multiple sclerosis), any other information relating to or provided by me about myself and my family, statements which may be attributed to me, and/or other indicia of identity (collectively, My Information) in any medium now known or hereafter developed, including any print, digital, or electronic usage, alone or in conjunction with other material, without restriction as to changes or alterations, for editorial, educational, press, promotional, advertising, and/or commercial purposes. I understand and agree that My Information is intended to be shared among the Society, Genzyme, their affiliates and agents, and others involved in the selection of the Program Participants. I also understand and agree that My Information may be shared with the general public, particularly in the event that I am selected to be a Participant, or I am involved in the Program in some other capacity. By agreeing to this Consent Statement, I hereby acknowledge and agree that I have no expectation of privacy regarding My Information under HIPAA or any state law, and I consent to the use and disclosure of My Information as described in this Consent Statement.
I understand that I will not have the right to further approve or inspect any photos, information, or materials, including the finished product, publication, story, videos, article, materials or the like.
Compensation
I understand that I will not receive any compensation, royalties or other reimbursement for providing My Information, applying to be a Participant in the Program, or agreeing to this Consent Statement.
Copyright Privileges
I understand that I have no copyright privileges for photos, information, or materials, including the finished product, publication, story, videos, article, materials or the like provided to the Society and Genzyme or their respective agents.
Expiration and Revocation
I understand that this Consent Statement shall remain in effect for the duration of the Program and that the Society and Genzyme may use My Information until this Consent Statement is no longer effective, unless I submit a written request to withdraw my consent to the use of My Information. I understand that I may withdraw my consent to the use of My Information by the Society at any time by sending a written request to withdraw to the National MS Society, Marketing Department, Everyday Matters Project, 900 South Broadway, 2nd Floor, Denver, CO 80209. I understand that I may withdraw my consent to the use of My Information by Genzyme at any time by sending a written request to withdraw to Genzyme Corporation, 500 Kendall Street, 5th Floor, Cambridge, MA 02142, Attention: Margaret McCormick. I further understand and agree that if I withdraw my consent, it will apply to new uses of My Information once the recipient has received and processed my withdrawal, but will not apply to any such use that is already initiated, such as advertising or promotional materials that have been developed and used or disseminated, or are in development. Neither the Society nor Genzyme has an obligation to cease using materials that have already been prepared with My Information.
Release
I hereby release and agree to hold harmless the Society and Genzyme, and their respective affiliates, employees, directors, officers, agents, and subcontractors from any and all liability, actions, causes of action, claims or demands for damages, costs, loss, expenses, compensation, consequential damage, and debts of any nature whatsoever (collectively, “Claims”) arising out of or in connection with my application to be a Participant in the Program, and all Claims caused by or arising out of the use of the rights granted hereunder, whether intentional or otherwise, including, without limitation, Claims of violations of the rights of privacy or publicity, Claims of violations of personal or property rights, Claims arising from alleged misrepresentation of me, my character or opinions or my person, Claims for faulty processing, distortion, reproduction or optical illusion, or any other Claims whatsoever. I hereby waive any right I may have to file a privacy complaint in connection with the Program and My Information.
Contact
I consent to being contacted (by phone, email, mail, or other mode of communication) by the Society and Genzyme in connection with the Program (as a potential Participant or for some other Program-related opportunity), and in connection with any future educational, marketing, press, scientific, commercial or promotional opportunities that it/they may wish to discuss with me (which such contact may continue after the conclusion of the Program).
Representations
I represent and warrant to the Society and Genzyme and their agents (including any third party vendors) that I own all of the rights to the materials that I provide in connection with the Program (e.g., written materials, photos, videos, etc.), and there is nothing to prevent me or restrict me in any manner from granting the rights, title and other interests granted hereunder. I will be fully responsible for any Claims to the contrary made by third parties.
I agree to be bound by the terms and conditions of this Consent Statement and to comply with all applicable federal, state, and local laws and regulations.
I represent that I am 18 years old or older and have every right to consent as set forth in this Consent Statement. I represent that I have read this Consent Statement prior to its execution and I understand the contents thereof before agreeing.
I understand that the Society and Genzyme reserve the right to cancel the Program at any time and for any reason.