I hereby give ActionCOACH and those acting pursuant to its authority, permission to publish my testimonial interview, video and photograph.

I hereby authorize ActionCOACH to:

1. Use my name, interview, photograph and testimonial in connection to any press, media release news article, collateral material, video or video testimonial.

2. Use my name and biographical material in connection with the same.

3. Publish or distribute the testimonial through print, video, multi-media or any other advertising mediums in whole or in part without restrictions or limitations for any educational and non-commercial purpose which ActionCOACH and those acting pursuant to its authority, deem appropriate; and …

4. To copyright the same in its name or any other name it may choose.

I hereby release and discharge, its successors and assigns, its officers, employees and agents, and members of the Board of Directors, from any and all claims and demands arising out of or in connection with the use of such information, including photographs, film or tape, including but not limited to any claims of defamation or invasion of privacy.

I hereby consent to the release of said interview, testimonial and photograph or any other medium for the above-stated purposes.