Satellite Event Submission

I hereby authorize The Patient Safety Movement Foundation (PSMF) and assign the rights to display, publicly perform, exhibit, transmit, broadcast, reproduce, record, photograph, digitize, modify, alter, edit, adapt, create derivative works, otherwise use, and permit others to use, the name, logo(s), publicly available data and images of the person listed above and its relevant affiliates on any platform and for any purpose including, but not limited to, advertising, public relations, publicity, packaging, and promotion of the PSMF without further consent or consideration from the person listed above.