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By clicking the submit button below, I hereby agree to and accept the following terms and conditions governing my
use of the ACS function on the ACS.com.ro website. I further reaffirm my acceptance of the general terms
and conditions governing my use of any Myriad website (including but not limited to the Support360™ website), which
general terms and conditions are incorporated herein by reference.
• I authorize ACS („ACS”) to use or disclose my protected health information,
including my name or other personal information, in whole or in part, as a story in an ACS publication (print or
electronic), an ACS website, audio, video, television commercial or film.
• I further authorize ACSto use or publish any media, including photographs, sound recordings, or videos, in an
ACSpublication (print or electronic), website, video, advertising or film for any purpose.
• I acknowledge that this authorization will remain in effect until I provide a written notice of revocation to ACS’s
Marketing Department, If I
revoke this authorization, I understand that ACS may not be able to reverse the use and disclosure of the
health information while the authorization was in effect.
• I understand that ACS will not receive financial or in-kind compensation from a third party directly in exchange
for the use or disclosure of my health information authorized for release by me.
• I understand that ACS will not condition treatment, payment, enrollment or eligibility for benefits on whether or
not I sign this authorization.
• I acknowledge and understand that the protected health information used or disclosed as a result of this
authorization may be subject to re-disclosure by the person or entity receiving such information, and thus no
longer protected by federal privacy regulations.
• I hereby assign to ACSany rights I may have in any content (including information or media) I may submit
using the ACS function of the Support360TM website, including but not limited to my image, my
likeness, the sound of my voice, as well as any underlying subject matter (all collectively „Materials”), as
recorded in any format, including but not limited to any audio or video recording and any written transcript of
such recording, without payment or any other consideration. I understand and agree that these Materials may
be edited, copied, exhibited, published or distributed and I hereby waive the right to inspect or approve the
finished product. Additionally, I hereby waive any right to royalties or other compensation arising from or related
to the use of the Materials, unless explicitly stated in a separate written agreement with ACS.
• I understand and agree that ACS may use the Materials for any purpose, including but not limited to the
following: conference presentations, educational presentations or courses, informational presentations, on-line
presentations, educational videos, and commercial and promotional activities relating to ACS’s products and
services.
• I understand and agree that this permission signifies that photographic or video recordings of me may be
electronically displayed, including but not limited to via the Internet. There is no geographic limitation on where
these materials may be distributed. I hereby release any and all claims against ACSin utilizing Materials
consistent with this document.
• I hereby warrant that I am eighteen (18) years of age or older and have every right to contract in my own name
in the above regard.

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