I hereby authorize and consent to the release of my likeness and information I provide to the organizations mentioned below to the media and/or to the making of photograph, video and/or audio of me and/or my loved one (deceased or living donor) by the New Jersey Organ and Tissue Sharing Network, Inc. (“NJ Sharing Network”) and the NJ Sharing Network Foundation, Inc. (the “Foundation”), its agents or employees. I hereby authorize and consent to the use of such information, photographs/video or audio in connection with publicity, education, corporate disclosure and other uses relevant to the mission of NJ Sharing Network and the Foundation, including but not limited to, newspaper stories,
television programs, public service announcements, website, social media outlets, newsletters, teaching, research and for the purpose of organ and tissue donation awareness regardless of the format whether now known or used in the future. I hereby release NJ Sharing Network and the Foundation, its board, agents and employees from all liability related to the making and use of such likeness and information.