Consent Form

CONSENT FOR USE OF MY STORY AND/OR PICTURES

I am a visitor to the website, Liposuction, Tummy Tuck (Abdominoplasty) & Body Contouring Information Resources, also known as www.liposite.com ("LipoSite"). I have agreed to contribute to the owner of LipoSite my story and/or pictures. I authorize LipoSite to display my information and photos on www.liposite.com for the purpose of providing women with an educational opportunity. I also acknowledge that Advice Media LLC ("Advice Media") is the entity that owns the website and hereby further authorize Advice Media to use my pictures and release Advice Media and LipoSite (Releasees) as follows.

I release the Releasees from any claim by me or anyone claiming on my behalf as successor, assign, beneficiary or heir, for the use of my name or pictures as set forth herein, and agree to permit Releasees to use my name or pictures for any purpose required or desired by the Releasees in promotional publications, advertising, educational presentation, broadcast, cablecast or any purpose sponsored by Releasees and their agents, successors, assigns, principals or subsidiaries. This Release shall also extend to my employees, principals and property. I further hereby release the Releasees from any liability for the distribution of the my pictures and also release all rights in and to any claim of copyright, trademark, trade dress, or other intellectual property or other rights, royalties, commission or any payment whatsoever in connection with the use of my pictures.

I understand that significant changes need to be made in order for LipoSite to display thse pictures or to remove them from the website and, therefore, agree to allow the use as set forth herein, indefinitely. By checking the box on the Visitor's Photo Gallery Submission Form, I agree to all of these terms.