With your permission, you will be contacted about your experience. But first, please review the Consent and Release. If you accept the terms, you will be prompted to provide your contact information.
Purpose of Consent and Release
By accepting the terms of this Consent and Release ("Consent"), you are consenting
Boehringer Ingelheim Pharmaceuticals, Inc. and its affiliated entities and officers,
employees, agents and other persons and entities they authorize ("BIPI") to use
the information in your Testimonial (as defined below). Your Testimonial means any
interviews, personal anecdotes, transcripts, quotes, images, likenesses or photographs
of or by you provided by you to BIPI, in any format or medium, now known or later
invented. Giving this Consent today does not mean that you are required to give
consent in the future for BIPI to create or use new Testimonials.
Consent and Release
I hereby consent to allow BIPI to take, use, store, reproduce, broadcast, disclose
and publish my Testimonial in presentations, publications or other public disclosures
on the Internet, and any other electronic, print, broadcast, live webcast or other
media for public relations, marketing and/or advertising for the purpose of assisting
in raising awareness of Transient Ischemic Attack.
I agree that nothing in this Consent obligates BIPI to use or continue to use the
Testimonials in any particular way, or at all. In addition, I understand, acknowledge
and agree to the following:
- In any event, I acknowledge that identifying characteristics in the Testimonials
could identify me.
- I waive any right to inspect, approve, disapprove, or request changes to, any of
- I will make no monetary or other claim for compensation or consideration now or
in the future in connection with the creation or use of the Testimonials by BIPI.
- If Testimonials are posted on a Web site by BIPI, then they might be downloaded
and posted or used elsewhere without BIPI's control or permission and agree that
BIPI shall have no liability for such actions.
- Copyright and all other rights to the Testimonials belong to BIPI alone unless otherwise
required by applicable law.
I hereby waive and release BIPI from any and all claims related to this Consent,
including, but not limited to, claims by me that any use of my Testimonial in accordance
with this Consent violates my rights of privacy and/or publicity.
I am of legal age and agree to this Consent, which I have read and understood. Any
questions I have about this Consent have been answered.