1. I declare that I am a doctor or health professional and bearer of the indicated CRM / Council Number and that all the information provided is true.

2. I declare that I am aware of and agree with the registration and cancellation rules available on the website.

3. I AUTHORIZE, as for this date and for an indefinite period, BEM SERVICOS EM EDUCACAO LTDA, CNPJ nº 43.344.798/0001-00, entity promoting the event, the rights to use my image and voice in any and all material produced during the event, including video images and photographs.

I reiterate that this assignment of use of image, voice and name is completely free, recognizing that BEM SERVICOS EM EDUCACAO LTDA does not and will not, owe anything, at any time, to me or any third part that may influence the object of this assignment.

I waive any right to claim, under my sphere, the prohibition of the use of my image, voice and name of the materials produced at the event, as well as the removal of these from the means of transmission, at any time.