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In what year do you plan to enroll in medical school? If you are applying in the application cycle that launches in May 2020 (May 2020 - April 2021), your entry year would be 2021.

I give permission to share my email with participating colleges of osteopathic medicine. *

In consideration of my engagement as a model, speaker, or other participant, upon the terms herewith stated, I hereby give to the American Association of Colleges of Osteopathic Medicine (AACOM), its legal representatives and assigns, those for whom AACOM is acting, and those acting with AACOM’s authority and permission:

a) the unrestricted right and permission to copyright and use, re-use, publish, republish, produce, reproduce, edit or modify, post electronically, broadcast, present, sell, transfer and distribute visual and/or audio media of me and/or my children, or other minors for whom I have legal responsibility, and our likenesses or visual and/or audio media in which I and/or my children, or other minors for whom I have legal responsibility, or our likenesses which may be included, in whole or in part, composite or distorted in character or form, without restriction as to changes or transformations, or reproduction hereof in color or otherwise, made through any and all media now or hereafter known for medical education promotion and recruitment purposes, or any other purpose whatsoever; and

b) the permission to use any printed material or visual and/or audio files in connection therewith.

I hereby relinquish any right that I may have to examine or approve the completed product or products that may be used in conjunction therewith or the use to which it may be applied.

I hereby release, discharge and agree to save harmless AACOM, its legal representatives or assigns, and all persons functioning under its permission or authority, or those for whom AACOM is functioning, from any liability by virtue of use of the filmed footage, any blurring, distortion, alteration, optical illusion, or use in composite form whether intentional or otherwise, that may occur or be produced in the taking of said visual and/or audio media or in any subsequent processing thereof, as well as any publication thereof, including without limitation any claims for libel or invasion of privacy.

I understand that I am not to receive payment for said visual and/or audio media or the rights granted herein.

I hereby affirm that I am over the age of majority and have the right to contract in my own name. I have read the above authorization, release, and agreement, prior to its execution; I fully understand the contents thereof. This agreement shall be binding upon me and my heirs, legal representatives and assigns.

I consent to the statements included in the Audio Visual Media Release above. *
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