By affixing my electronic signature below, I hereby irrevocably grant to Blaine Company Inc., dba Blaine Pharmaceuticals ("Blaine"), the right to attribute the attached statement (or statement in different words which have substantially the same meaning) to me, which is a true and correct expression of my personal experience and belief and to use such statement as a testimonial to Blaine's RELIADOSE™ product. I understand that Blaine may use my statement in various media including press, radio, television, Internet and other promotional materials without compensation to me, edit my statement for length and content, and use my name in connection with the statement.
I also release Blaine, its affiliates, officers, directors, agents and employees, its advertising agency, licensees, and producers or publishers of its promotional material, those acting under its authority, and its successors and assigns from any and all claims and demands, whether now known or unknown, arising in connection with my statement, name or photo including claims for defamation, libel, violation of any moral rights, invasion of privacy, publicity or personality or any similar matter, or based upon or relating to any use, publication, distribution or other exploitation of my statement or my name in connection therewith.
I also represent and warrant that I am over the age of eighteen (18) years, that I have the credentials I represent and am the person identified below, and that I have read and understand the contents of this Release.