I grant to Dr. Wansoo Im, its representatives , the right to take photographs of me in connection with the above-identified subject. I understand that these photographs may be used for any lawful purpose, including but not limited to publicity, illustration, advertising, and web content. I agree that Dr. Im may use such photographs of me with or without my name.

By signing below, I acknowledge that I have read and understood the above information and give my consent for the use of my photograph(s).