BUSINESS CARD RELEASE

I hereby grant William Esteb, Patient Media, Inc. or its assigns the right to reproduce my business card in print and electronic media for the purpose of inspiring other chiropractors to upgrade their business card design and project a more contemporary image of the profession.

I retain all ownership of this design and am merely granting the right to its reproduction. With my signature below, I declare that I am the owner of this design and have the right to grant these reproduction rights.

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Name (Please print)

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Address

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City, State and Zip/Postal Code

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Signature

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Date

Sign and enclose two copies of your business card along with any narrative you'd like to share about its design or creation and mail to:

William D. Esteb
Patient Media, Inc.
860 Commercial Lane
Palmer Lake, CO 80133