PERMISSION RELEASE FORM TO USE NAME AND STATEMENT I hereby grant permission to GLASSESOFF INC. and any affiliated company, (“The Company”) the right to use my Personal Information, Statements, Pictures and Video file attached hereto or reasonable derivations thereof (to include translation into different languages) for various marketing purposes, including in all forms of media, newspapers, internet websites, in collateral materials and other similar documents, materials and sites. At any time I may inform The Company in writing; that I revoke this approval and the company hereby commits to make reasonable commercial efforts to remove my information from all its websites and marketing materials.
