I, the undersigned, hereby grant to The Regents of the University of California, on behalf of the University of
California, San Diego, its officers, and employees (collectively referred to herein as "UCSD") and its agents
and assigns the worldwide, perpetual, irrevocable right to: (1) photograph, film, videotape and/or record the
undersigned; (2) reproduce, distribute, display, create derivative works of and otherwise use the undersigned’s
name, photograph, sound recording, motion picture, video and/or likeness for or in connection with UCSD’s
educational mission, research mission, public relations, publicity, promotional or recruitment
purposes/activities, by any means, methods and media (print and electronic) now known or in the future
developed that UCSD deems appropriate.

I make this grant of rights with the understanding that no compensation will be paid to me by UCSD for such
grant. I understand and agree that all right, title and interest, including copyrights, in the materials created by
UCSD pursuant to this agreement are the exclusive property of UCSD and that I will obtain no rights in such
materials. I also understand that UCSD is not actually required to use my photograph, sound recording, motion
picture, video and/or likeness in any way.

I hereby waive any right that I may have to inspect or approve any photograph, sound recording, motion
picture, video and/or likeness, or derivative work thereof made pursuant to this agreement. I understand that
under California law individuals may generally have certain legal rights to control the use of their names,
likenesses recordings, and images and I hereby release all such rights, including but not limited to any and all
claims for invasion of privacy, defamation or infringement of copyright. I further agree to hold harmless
UCSD, its agents, licensees, and assignees from, and will neither sue nor bring any proceeding against, any
such parties for any liability, whether now known or arising hereafter, resulting from or arising in connection
with the exercise of such parties’ rights pursuant to this agreement.

I have read the above agreement and fully understand its contents. I represent and warrant that I am of full age,
that I have the right to contract in my own name, and that I have no pre-existing obligation that may restrict or
limit my ability to sign this agreement.

This agreement will be governed by the laws of the State of California and represents the final and exclusive
agreement between UCSD and myself on this subject.