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Consent Form

Sovereign Health Group appreciates your willingness to cooperate in written, audio and/or video materials for our Company publications and other business-related purposes.

This release form indicates your consent to Sovereign Health Group’s right to use your written statement, PowerPoint, audio and/or video recording(s) and to assure that the Company’s records are complete with regards to the availability of each recording.

I, the undersigned, grant to Sovereign Health Group (“Company”) and its licensees, successors and assigns (collectively called the “Licensed Parties”) a worldwide, perpetual right and license to use, reproduce, print, publish, broadcast and rebroadcast my materials in any and all media and types of advertising and promotion (collectively referred to as “Advertising”) for Company and its services. I understand that full credit will be provided to me by Sovereign Health Group for all usage of my materials.

I understand that I will have no right to any compensation in connection with the Licensed Parties’ use of my name, testimonial, statement, voice, picture, or likeness.

I am of the age of 18 or older and have the right to contract in my own name with respect to this Consent and Release.