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Primordial Alchemist, Inc.  Video Waiver and Release Form  * [email protected]

I hereby grant permission to Primordial Alchemist, Inc., the rights of my image, in video or still, and of the likeness and sound of my voice as recorded on audio or video tape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area.

Photographic, audio or video recordings may be used for ANY USE which may include but is not limited to: * Presentations; • Courses; • Online/Internet Videos; •Media; • News (Press); *Advertising purposes

I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet or in the public educational setting. I understand that Primordial Alchemist, Incwill own and retain all rights and that this does not form a professional relationship between Primordial Alchemist, Inc. with any other party or entity. There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.

This release applies to photographic, audio or video recordings collected as part of Primordial Alchemist, Inc. sessions, trainings, workshops, events, that you take part in, attend, or join.

I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for purposes outlined in this document.