Duke University Medical Center
Durham, North Carolina 27710

Name:_________________________________________________

Production Title:_________________________________________

Production Date(s):______________________________________

I am participating in the live production described above. I understand that it is part of an event, sponsored by Duke University that is being electronically transcribed (recorded) for live or delayed distribution.

In consideration for value received, I hereby relinquish all right, title and interest to the presentation listed, and transfer all such right, title and interest to Duke University (Duke).

I understand that this means that Duke is entitled to claim copyright and use final electronic images (including audiotape, videotape and/or film recordings) of me and my presentation materials in connection with this production in any manner or form for any lawful purpose at anytime.

I realize that Duke University shall have the right to edit, distribute, rebroadcast, or sell the product of this presentation in any format and in any medium and I shall have no right to recover royalties or any other form of compensation.

I waive any right that I may have, if any, to inspect or approve the finished product or the written copy that may be used in conjunction with this production.

I release and discharge Duke from any liability to me by virtue of any alteration that may occur, in the making or editing of this production.

I agree to hold Duke harmless for any liability to others arising from the use of anything I may say or do during this production and recording.

I warrant that the material contained in my presentation is original or, if it is copyrighted material owned by third parties, I have obtained the necessary rights to include such material in my presentation and to grant the rights in this release to Duke.

I understand that Duke grants to me a license to use and distribute for non-commercial purposes any audiotapes, videotapes, and/or film recordings that are the subject of this authorization and release.

I have read this agreement before signing below and I fully understand its contents.

Signed:_________________________________________________

Date:___________________________________________________