Event Registration
Revision Knee Masters Course

Maxx Orthopedics Inc. – Media Release Authorization
I hereby grant to Maxx Orthopedics Inc. ("Maxx Orthopedics") the right and permission to photograph, film, and/or record me, and to use, reproduce, modify, distribute, and publicly display such media for educational, promotional, marketing, training, or internal purposes. This authorization applies to all formats and media now known or later developed, and is granted worldwide and in perpetuity.

I understand and agree that:
• My name, title, and organization (as set forth in the signature block) may be used in connection with such media.
• I will not receive compensation for the use of the materials.
• Maxx Orthopedics is not obligated to use any media in which I appear.
• No patient-identifying information (PHI) will be disclosed or included.

I hereby release and discharge Maxx Orthopedics and its affiliates, employees, agents, and representatives from any and all claims, demands, or causes of action related to the use of such media as described above.