I voluntarily give my permission for UT Health Science Center staff to record me {or my child or an individualto whom I provide guardianship) on video/audio tape, photographic film or any other medium includingsocial media. I authorize use of my {or my child's or an individual's to whom I provide guardianship) name, likeness, voiceand biographical material in Health Science Center publications and website -to include electronic andprinted magazines, brochures, newsletters and the Internet and its social media {e.g., Facebook, Twitter,etc.)-as well as in its dissemination of information to the news media ------for publicity for the University andits programs. I give the Health Science Center the right to exhibit or distribute such representations, in whole or in part,without limitations, for any educational purpose that the Health Science Center, and those acting under itsauthority, deem appropriate. I understand that I may withdraw or revoke my authorization at any time and such revocation must be givento the Health Science Center in writing. If I withdraw my permission, my image/information may no longerbe used or released for the reasons covered by this authorization. However, I understand that any releasemade prior to a revocation may remain in public domain. I further understand that no special favors, payment or any other compensation have been promised to mefor agreeing to this authorization.
