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    I hereby authorize and give permission for the participant’s name, photograph, video and/or other identifying information (such as age, eye condition, etc.) to be used by The Chicago Lighthouse for publicity, collaborative or training purposes. I understand such uses may include brochures, newsletters, website entries, press releases or written stories without payment or any other compensation. I further understand some uses may be for information and material sent to other organizations/companies (newspapers, television, radio, conference presentations, etc.) and that the materials will become the property of The Chicago Lighthouse and will not be returned.

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