Award recipients will be required to submit a wallet-size, color photo for announcement on BioMatrix social media sites and printed publications.
In consideration of my acceptance of this scholarship, should I be selected as an award recipient, I will be asked to authorize BioMatrix, and its representatives or agents, to use and disclose the information contained in this application about me or my child, including protected health information as defined by federal and state law, for use in publications and to the general public or media. The information may include my or my child’s name, age, treatment, duration of treatment, treatment plan, diagnoses, medication, city and state of residence, photographic images, video, audio, identifying information, and other information about my or my child’s life and experience as a patient of BioMatrix. The information may also be disclosed to external media and may be disclosed in the following, but not limited to, forms: press releases, stories, photographs or video clips. It may also be used for publications produced by or on behalf of BioMatrix, including but not limited to advertising, promotional and marketing materials (“Materials”). Such Materials may include sales and educational brochures, display boards, sales campaigns, promotional items, company newsletters, social media, and websites. I authorize BioMatrix to use, reuse, copy, publish, display, exhibit, reproduce, license to third parties, and distribute the materials in any educational or promotional materials or other forms of media, which may include, but are not limited to articles, magazines, advertisements, recruiting brochures, websites or publications, electronic or otherwise, without notifying me. I understand that I will not be compensated in any way for the taking or use of my or my child’s information, photographs, films, audio, and/or video. I understand that BioMatrix will not condition treatment on my provision of this authorization. I understand that any information used or disclosed pursuant to this authorization is no longer protected by federal law and may be re-disclosed.