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By uploading my photograph, I permit Amylyx Pharmaceuticals, Inc. and its successors, agents, and assigns (collectively, “Amylyx”) to use, re-use, copy, modify, alter, create derivative works from, publish, broadcast and display my image, statements or other likeness of me (alone or with other persons) in my photograph I provide, without payment or other compensation. I agree that my photograph may be used on the #INKEDforALS website as well as in Amylyx print and electronic materials for the promotion of the #INKEDforALS campaign. Additionally, I waive any right to inspect or approve the finished product in which my photograph appears and release Amylyx from any and all liability arising out of or in any way connected to Amylyx’s exercise of these rights for purposes in furtherance of promoting ALS awareness. There is no time limit on the validity of this release nor is there any geographic limitation on where these rights may be exercised. I understand that Amylyx reserves the right to post or not post a photograph submission for any reason, including to reject photographs that are not consistent with the Terms of Use. I certify that I have read and understand Amylyx’s Privacy Policy, am eighteen (18) years of age or older, have legal capacity to sign this form, and have obtained any appropriate or required consents from all identifiable persons in my photograph (or from the parent or legal guardian of any such person who is under the age of eighteen (18), as applicable) to submit my photograph to Amylyx in accordance with the terms described above.

By checking this box, I confirm that I want to receive information from Amylyx Pharmaceuticals, Inc., including by email, and have reviewed the Privacy Policy provided in the Terms of Use.

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