ASCRS Ophthalmology Hall of Fame Exhibit Submission Form and Agreement

 

The American Society of Cataract and Refractive Surgery (ASCRS) has been proud to induct over 40 members into the ASCRS Ophthalmology Hall of Fame for their contributions to the science and practice of ophthalmology.

The ASCRS Ophthalmology Hall of Fame was created by ASCRS in 1999 to honor pioneers with an ongoing celebration of their distinguished career and contributions.

ASCRS is pleased to announce the opening of our 11th ASCRS Ophthalmology Hall of Fame Exhibit, which will have memorabilia on display at our upcoming 2016 ASCRS•ASOA Symposium & Congress,
May 6 – 10, 2016 in New Orleans, LA. You are invited to submit pertinent items for exhibit (either an actual item or photograph—see waiver agreement enclosed). In addition to items received by ASCRS Ophthalmology Hall of Fame honorees, we also plan to have photos of each honoree and biographical information.

We plan to have items on display each year at our Annual Symposium & Congress. In order to plan the size of this exhibit at each Symposium, we ask that you complete the attached ASCRS Ophthalmology Hall of Fame Submission Form and return to our office. Due to certain restrictions, not all submissions can be selected for display. Your participation is encouraged. If you have any questions, please contact
Tara Reddy at treddy@ascrs.org or (703) 591-2220.

Please note the questions on the below submission form, especially those concerning insurance value and loan conditions.

 

Please complete ONE (1) form for each item you wish to submit for display—PLEASE TYPE.

ASCRS OPHTHALMOLOGY HALL OF FAME EXHIBIT MATERIAL PARTICIPATION AGREEMENT
Loan an Item

WAIVER and RELEASE:

I, the Releasor, being lawful owner of said exhibit material, am, in consideration of Releasor’s exhibit item(s) being accepted for inclusion in the ASCRS Ophthalmology Hall of Fame Exhibit, scheduled for May 6–10, 2016 do hereby forever WAIVE, RELEASE and DISCHARGE the Releasee, and officers, directors, employees, agents, affiliates, and other representatives (collectively referred to here as “Releasees”) of and from any and all actions, suits, liabilities, claims, demands, loss, or damage of any kind or nature whatsoever, whether at law or in equity, that the Releasor has or may have against any of the Releasees, whether or not currently asserted or known, which may arise, in whole or in part from inclusion of the exhibit material in said exhibit, except to the extent that any damage to the item is caused by Releasees’ gross negligence or willful misconduct. Unless Releasor has filled out the bottom portion of this form for exhibit item(s) on loan to Releasee, Releasor by signing this agreement understands that it is loaning the exhibit item(s) to Releasee and that ASCRS will take reasonable measures to protect and return exhibit item(s) in the same condition they were received.

I hereby acknowledge and agree that I have carefully read this Waiver and Release agreement, that I fully understand same, and that I am freely and voluntarily executing same.

By signing this release I will be forever prevented from suing or otherwise claiming against the Releasee for any property loss or damage unless such loss or damage is caused by Releasees’ willful misconduct or gross negligence while being exhibited or prepared to be exhibited and I understand I may not be compensated for such loss or damage.

I understand that this Waiver and Release agreement is binding. This release contains the entire agreement between the parties.

This Waiver and Release Agreement will be construed in accordance with the laws of the Commonwealth of Virginia.

I hereby acknowledge and agree that I have carefully read the above Waiver and Release agreement, that I fully understand same, and that I am freely and voluntarily agreeing to the terms above except that I am loaning the exhibit material to Releasee rather than donating it to Releasee.

I HAVE READ AND UNDERSTAND THIS AGREEMENT, AND I AM AWARE THAT BY CHECKING THE BOX ON THIS AGREEMENT I AM WAIVING LEGAL RIGHTS AGAINST THE RELEASEE(S)

Donate an Item

RELEASE:

I understand that the item(s) is donated to ASCRS and that exhibit material becomes the property of ASCRS and may be used by Releasee in subsequent exhibits or for other similar purposes, their associates involved in the exhibit for the above noted activity and each of their associates will take reasonable measures to protect this item(s) however it is understood item(s) will not be returned and no recourse whatsoever can be taken should damage or loss occur regardless of the cause of the damage or loss. Further, I have read and voluntarily agree to all of the terms of the above Waiver and Release, which are incorporated by reference in this Release as well.

I hereby acknowledge and agree that I have carefully read this Waiver and Release agreement, that I fully understand same, and that I am freely and voluntarily executing same.