Video Release

By signing below, I acknowledge that I have read, fully understand, and agree to the following terms for Google
to use audio-video footage and/or transcript(s) of my presentation externally, on YouTube and other Google
services (the “Google Services”).

I hereby grant Google Inc. and Google's partners, affiliates or sublicensees (collectively "Google")
permission to copy, host, index, display, route, reformat, distribute, store, transmit, and perform
audio-video footage and/or transcript of my presentation on the event date indicated below, on
the Google Services as live streamed footage and archived footage. I grant Google a royalty-free,
perpetual, worldwide license to any copyrights, rights of publicity, music licensing rights and any
other legal rights necessary worldwide in order for Google to make this authorized use of the
audio-video footage and/or transcript.

I warrant that I have the authority to grant this permission and to make the
acknowledgments and consents set forth herein on behalf of my company, to the extent
that my company's permission, acknowledgment or consent is required.

I acknowledge that I will not be paid (nor will my company, if applicable) for use of the
audio-video footage and/or transcript(s) of my presentation and hereby relinquish (and
with respect to my company, if applicable) any past, present, or future monetary or
other claims against Google for this use. I also waive (and with respect to my company, if
applicable) any moral rights that I might have in my name, likeness or presentation.

I represent that I am at least 18 years of age; that I am competent to contract in my own

name on behalf of myself or my charge; and that, to the best of my knowledge, material
included in my presentation is my own original material or material for which I have all
necessary legal rights to grant the authorizations set forth above.

I understand that I am free to address any specific questions regarding this release by
submitting those questions in writing prior to signing, and I agree that my failure to do so
will be interpreted as a free and knowledgeable acceptance of the terms of this release.

Printed Name:___________________________________________

Signature: ______________________________________________

Date: ___________________

Event Date: ______________

Video Release Form: 09/26/12