Grant and Release

I have been informed that Peggy de Azevedo and Rebecca Cengiz (the "Authors") are currently working on a book about being single in a culture of couples and the challenges single people face in the world today (the “Book”).

I hereby consent to the Author’s use of my responses to a survey or an interview with the Author, comments as quoted or derived from the survey or interview and any materials I provide to the Author, in the publication, advertising, or promotion of the Book, and any editions or revisions thereof, in any languages, throughout the world. I hereby consent to the Author’s use of any incidents or episodes in my life, in preparation, production, performance, broadcast, exhibition, including, but not limited to, merchandising, publication, and other allied rights therein.

I understand that the Book and/or portions thereof may be published in newspapers, magazines, and other printed or electronic media and may be released or distributed in other recorded media, such as television, motion pictures, computer disk, video disk, the Internet, and by other electronic means. I hereby consent to all such derivative uses, including the exhibition and publication in any and all media, now known or hereafter discovered throughout the world in perpetuity. All rights granted herein may be assigned to other individuals, entities, licensees or successors.

I wave any claim, and I release Author and Author’s assigns, licensees and successors from any claim, in connection with the aforementioned use or uses, including, but not limited to, claims relating to defamation, invasion of privacy, infringement of moral rights, slander, libel, copyright or otherwise. I acknowledge that I have no ownership rights in the Book, and I waive any right to inspect or approve any portion of the Book.

Author is not obligated to utilize the rights granted in this Agreement. I have read and understand this agreement, and I represent and warrant that I have full right, power, and authority to execute this Agreement, and I am over the age of eighteen. This Agreement expresses the complete understanding of the parties.