Pre Register

Please ensure your image is less than 5MB and in one of the following file formats : png, jpeg, jpg, gif, bmp, tiff
Please ensure your image is less than 5MB and in one of the following file formats : png, jpeg, jpg, gif, bmp, tiff
By submitting my responses to the pre-registration questions above ('Pre-Registration Responses') in connection with my interest in participation in the television program 'Extreme Weight Loss' ('Program'), I hereby consent to the recording, use and reuse by Eyeworks USA, LLC & Bongo, LLC ('Producers') and American Broadcasting Companies, Inc. ('Network'), and any of their respective licensees, successors, assignees, parents, subsidiaries, related or affiliated entities, and each of their respective employees, agents, representative, officers and directors (collectively "Releasees") of my voice, actions, likeness, name, appearance, biographical material, and any information (including private or otherwise confidential medical information) contained in, derived from or obtained in connection with my Pre-Registration Responses or in any materials or information submitted by me in connection with my Pre-Registration Responses and/or application to participate in the Program (collectively "My Likeness and Information"), as edited, altered, or modified by the Producers or by any of the other Releasees, in any and all media now known or hereafter devised, worldwide in perpetuity, in and in connection with the Program or otherwise . I agree that the Releasees or any of them may use all or any part of My Likeness and Information, and may alter or modify it regardless of whether or not I am recognizable. I further agree that Releasees may use My Likeness and Information in and in connection with the Program or otherwise, and in connection with advertising, programming and publicity materials for the Program (including, without limitation, in commercial tie-ins) and/or for Producers or Network. I grant the rights hereunder whether or not I am selected to participate in the Program in any manner whatsoever. I understand that I will not be paid any money for giving Releasees these rights or for submitting my Pre-Registration Responses. Furthermore, by submitting my Pre-Registration Responses, I hereby release each of the Releasees from any and all claims in any way directly or indirectly related to or arising from my application for or participation in and in connection with the Program, the submission or use of my Pre-Registration Responses and/or My Likeness and Information in any manner and/or the use of any rights granted by my herein.

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