By ticking the box below, I/we hereby expressly consent to, Hemab, Inc. 101 Main Street Suite 1220 Cambridge, MA 02142 (hereinafter referred to as the “Company”), to use my/our image, voice, personal story and/or contributions and/or those of my/our child which I/we have provided or will provide to the Company (the “Recordings”) to generate materials created from or incorporating the Recordings (“Materials”) to be used for the purposes described in this authorisation, including (without limitation) making the Materials available on the Company’s website and other Company-controlled channels.
For these purposes, I/we grant the Company a worldwide, royalty-free, non-exclusive licence to:
•Edit, adapt, crop, translate, subtitle, combine, synchronise with audio and/or visual works, create derivative works from, and otherwise modify the Recordings, and to incorporate the Recordings into the Materials in whole or in part; and
•Reproduce, display, perform, make available, distribute or otherwise use the Recordings included in the materials, in any format and via any media known or hereafter developed.
The Company may use the Materials and the Recordings incorporated in it for internal communication, marketing, promotional, educational and informational purposes, and in connection with the Company’s products, services, brand and corporate activities, including in medical conferences or seminars worldwide as relevant to the purposes described in this authorisation.
The rights set out herein are granted for a period of five (5) years from the date of this authorisation.
This consent applies to all forms and media of use, including video media distributed via the internet, such as live-streaming systems, videoconferencing systems, and video streaming platforms.
I/we acknowledge and agree that the Company shall own all rights, title and interest in and to the Materials. I/we hereby assign to the Company absolutely with full title guarantee all my/our rights, title and interest in and to the copyright and all other intellectual property rights throughout the world, including by way of present assignment of future rights, in the Materials.
I/we waive, to the fullest extent permitted by applicable law, any moral rights or similar rights I/we may have in the Materials and agree not to assert such rights against the Company or its affiliates or licensees.
I/we warrant that I am/we are not bound by any exclusive agreement relating to the use of the Recordings and that, if applicable, my/our child is not bound by such agreement either.
Information Regarding the Processing of Personal Data
The Company is the controller of the personal data collected pursuant to this form.
If I am/we are based in the United Kingdom, Switzerland or in the European Economic Area, I/we understand that the legal basis for the processing of personal data (including health-related data) is my/our (and my/our child as applicable) explicit consent pursuant to Article 6(1)(a) and Article 9(2)(a) of the General Data Protection Regulation (GDPR). Consent is given by ticking the box below.
Such data will be retained for the duration of this authorization and subsequently archived for a period of five (5) years, unless my/our (and/or my/our child’s) consent is withdrawn sooner.
The personal data may include the name, signature, image, voice, video recordings and photographs of me (or my/our child, as applicable), information relating to Von Willebrand Disease and other health-related information voluntarily provided by me/us (or my/our child, as applicable) in the Recordings. Where my/our child is the participant, the data may also include my/our name as my/our child’s parent/legal representative.
I/we understand that the website is publicly accessible and that everyone accessing the website will have access to the data.
Personal data will be transferred to the Company’s affiliates, including those located in the United States of America, using appropriate legal mechanisms and safeguards, namely the Standard Contractual Clauses of the European Commission,
I/we acknowledge that I/we (and/or my/our child, as applicable) have the right, at any time, to request access to my/our (and/or my/our child’s, as applicable) personal data, to correct any inaccuracies, and, in certain circumstances, to request deletion or restriction of processing. I/we further understand that I/we may also obtain my (and/or my/our child’s, as applicable) data in a format that enables electronic transfer to other organizations.
I/we understand that I/we may withdraw my consent at any time, and that withdrawal of this consent will not affect the lawfulness of processing carried out before the withdrawal.
I/we understand that if I/we withdraw consent, videos, photos, and other digital and printed supports incorporating my/our and/or my/our child’s image and/or voice processed on the basis of that consent will be deleted. However already distributed printed, physical materials, such as printed brochures that have been physically handed out, may remain in existence where a recall cannot reasonably happen.
For French residents: I/we also understand that I/we may also provide instructions regarding the processing of my/our (or my/our child’s, as applicable) personal data in the event of my/our death, or regarding my/our child’s personal data in the event of the child’s death.
My/our child may exercise these rights in their own name upon reaching the age of majority, and I/we undertake to inform them accordingly.
To exercise these rights, I/we understand that I/we may contact: Hemab, Inc.
I /we understand that in the event I/we wish to make a complaint regarding the handling of my/our and/or my/our child’s personal data, I/we may contact the Company’s Data Protection Officer using the details provided above or, if necessary, lodge a complaint with the relevant Data Protection Authority.
