By my signature below, I hereby authorize LCMC Health and its affiliates to disclose to media representatives or otherwise publish, online or in print, information about me, including my likeness on photo, videotape, and digital media, and statements that I have made on recordings for purposes of public relations, marketing, education, fundraising, or in response to news or media inquires. This authorization includes my likeness on photo, videotape, and digital media.
I understand that:
- by signing this authorization, the disclosed information enters public domain.
- this authorization will remain in effect until revoked, I may revoke this authorization at any time by contacting the LCMC Health Marketing department. My revocation will take effect upon receipt.
- if my consent is revoked LCMC Health will make reasonable efforts to remove previously released information from its electronic platforms. I understand that information released prior to this revocation may have been printed and/or electronically released to public platforms that are irreversible.
- I have a right to receive a copy of this authorization upon request.
- I may refuse to sign this authorization.
- I may request cessation of filming or recording at any time.
- I will not receive financial compensation.
- I may refuse to sign this authorization, and my refusal will not affect the terms and conditions of my employment.
