To further its educational objectives, the Stanford Biodesign Program desires to obtain license to use conference participants' names and images. We ask that you grant permission for photos and multimedia/video recordings of you and accompanying captions bearing your name to be used in future photos, videos, newsletters, reports, web pages, and other educational and promotional materials related to the Emerging Entrepreneurs Workshop. By processing payment, I confirm agreement between myself and the Stanford Biodesign Program.

If for any reason you do NOT wish to grant permission for your photo or name to be used, please express your preferences to an Emerging Entrepreneurs Workshop staff member at the Registration Desk on October 6, 2007.

I hereby grant the Stanford Biodesign Program and its respective successors and assignees, and Stanford Biodesign thereby accepts, a non-exclusive, perpetual license to use my name and image for promoting the Emerging Entrepreneurs Workshop and its educational mission, including without limitation, use in websites, print media, videos, and any other media or in any other manner as determined by Stanford Biodesign and the Emerging Entrepreneurs Workshop sponsors.