By attending an Dermatology Times Case-Based Roundtable ("Event"), all participants, attendees, sponsors, and guests ("you") create an agreement between you and Dermatology Times regarding the use and distribution of your image, including but not limited to your name, voice, and likeness ("Image"). By attending the Event, you acknowledge and agree that photographs, video, and/or audio recordings may be taken of you and you grant permission to Dermatology Times (and its agents) to utilize, in perpetuity, your Image in any electronic or print distribution, or by other means hereinafter created, both now and in the future, for any lawful purpose as determined by Dermatology Times.

NOTE: Name and address information provided below must match your W-9 form so that your compensation can be processed by HR&A®.