The Indianapolis 500

(Select all that apply.)

(Select all that apply.)

Without expectation of compensation or other renumeration, now or in the future, I hereby give my consent to Clarience Technologies, LLC and its affiliates and agents (“Clarience”) to use my photograph, my voice or quotes/excerpts of my written or verbally expressed words, my name, my alias, a video or audio recording or other likeness of myself (“My Likeness”) in its publications, advertising or other media activities. I understand that if there are certain aspects of My Likeness that I DO NOT authorize Clarience to use, I have indicated those below. I understand My Likeness may be used for internal purposes, such as for a post on the Clairence-wide Intranet, or for external purposes, such as in a LinkedIn post or on the Clarience external website, and if I DO NOT authorize use of My Likeness for either internal or external purposes, I have indicated that below. I understand that My Likeness may be copied/reproduced and distributed by means of various media, including but not limited to, video presentations, television broadcast/rebroadcast, radio transmission/retransmission, news releases, mailers, e-mails, billboards, signs, brochures, placement on social media, websites and/or electronic delivery, publication, display, or promotion on any and all other media, and I further understand that My Likeness may be subject to reasonable modification or editing. I waive my right to inspect or approve the finished product or material in which Clarience may use My Likeness. I understand that if I do not want the Company to use My Likeness as set forth in this Authorization, I have selected the “opt-out” option below. I understand that, although Clarience will endeavor to use My Likeness in accordance with standards of good judgment, Clarience cannot warranty or guaranty that any further dissemination of My Likeness will be subject to Clarience’ s supervision or control. Accordingly, I release Clarience from any and all liability related to the dissemination, reproduction, distribution, and/or display of My Likeness in print or any other media, including, without limitation, social media, and any alteration, distortion or illusionary effects of My Likeness, whether intentional or otherwise, in connection with said use. I also understand that I may not withdraw my permissions for use of My Likeness which was granted in this Authorization and that this Authorization is binding on my heirs, successors and assigns.