I understand my testimonial as outlined above (the "Testimonial") and made on behalf of [Transplant Counsellor] (hereinafter called "Transplant Counsellor") may be used in connection with publicizing and promoting Transplant Counsellor. I authorize TC to use my name, brief biographical information, picture and the Testimonial as defined on this form.

I hereby irrevocably authorize Transplant Counsellor to copy, exhibit, publish or distribute the Testimonial for the purposes of publicizing Transplant Counsellor's services or for any other lawful purpose. These terms may be used in printed publications, multimedia presentations, on websites or in any other distribution media. I agree that I will make no monetary, legal or other claim against Transplant Counsellor for the use of the statement.

In addition, I waive any right to impact where in my testimonial appear. I hereby hold harmless impact and release Transplant Counsellor from all claims, demands and causes of action which I, my heirs, representatives, executors, administrators or any other person acting on my behalf or on behalf of my estate, may have by reason of this authorization.

have made the authorization and release information and give my consent for the use of my testimonial as indicated above.