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Consent and Release Agreement

1. I am over the age of eighteen (18) years old. I hereby consent to the use of my Personal Representations, whether made in the past, present or future, by Union Security Insurance Company, its employees, agents, assigns, subsidiaries, affiliates and associated entities (collectively the “Company”), for the development of Communications for the Company's internal or external use or for distribution or publication, both on a limited and a general basis, for informative purposes, and for the advertising, marketing or publicizing of the Company and its products or services.
2. I understand that the phrase “Personal Representations” includes but is not limited to the following: my biographical or occupational description, name, picture, silhouette, profile, other representations of my likeness, voice, phrases and/or statements regarding me.
3. I further understand that the term “Communications” includes but is not limited to the following: brochures, sales aids, online media, web sites, image recordings, video recordings, videotapes, sound track or audio recordings, still photographs, commercials, or other media, whether presently existing or subsequently invented or developed.
4. I also grant to the Company and to anyone acting under the authority or permission of the Company, the right to make originals or reproductions of the Communications in whatever form, to use for any business purposes and to copyright any of the Communications.
5. I hereby waive all rights in the Communications, including but not limited to any right of inspection, review or approval, and I waive all rights to any form of compensation, both presently and in the future, with respect to the Communications and their use by the Company. I also agree that such Communications and all reproductions, including but not limited to plates, negatives, and other exposed film connected therewith, audio or video tapes, compact discs and all other means of storing Communications, are and shall remain the sole property of the Company, which shall have the right to copyright or otherwise legally protect both the Communications and the means by which such Communications are stored.
6. I agree that Company shall be without liability to me for any distortion or illusionary effect resulting from the publication of my picture, portrait, likeness, or any other Personal Representation. I further warrant and represent that this Release does not in any way conflict with any existing commitment on my part. I hereby agree to indemnify the Company from and against any and all liability arising out of the exercise of the rights granted by this Release.
7. Nothing in this Release shall constitute any obligation on the part of the Company to make any use of any of my Personal Representations or of any of the other rights set forth herein.

In consideration of the mutual promises and covenants set forth, I execute this Release on this date.  By consenting below, I agree and acknowledge that I understand all terms.

Consent to Electronic Agreement

I affirmatively consent to completing the Consent and Release Agreement (the “Form”) electronically. I understand that the option to receive and complete a paper version of the Form is available by printing the Form and completing and submitting the Form. I acknowledge that by clicking on the “I CONSENT” box below, I have consented to Union Security Insurance Company and its legal affiliates (hereafter “Company”) and that Company may use this information. I understand that the Company may be required to retain records of all relevant communications pertaining to the transaction. I also acknowledge that those records may be kept so that the Company may show that the records are authentic, were reliably created by me, and were created and linked to the electronic transaction to which they relate in a manner, such that if the record or the signature is intentionally or unintentionally changed after signing, the electronic signature is invalidated. I understand that I may withdraw this consent to completing the Form electronically by providing notice of my intent to do so to the Company or its agent(s) and that I have an opportunity to review this consent, as well as the Form, in written form as soon as practicable upon my request. I agree that all of the foregoing statements are true and I agree with the terms of this consent.