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PLI Physician Leadership Course


The purpose of this consent and release form is to request your permission for the Canadian Medical Association and/or its subsidiaries (“CMA”) to publish your comment(s) provided on the evaluation form regarding the PLI Physician Leadership course that you recently attended.

  1. You agree to allow CMA to use your comments reflected in a testimonial(s) for the intended use of promoting PLI courses. The publication may be in any medium, including print and electronic form, and may be posted on CMA’s social media Channels, including CMA’s website, CMA’s twitter account, and CMA’s YouTube Channel. You understand that only CMA can post video onto its Channels, but that it can be read by anyone through a link provided on CMA’s website or CMA’s twitter account or CMA’s YouTube Channel. You further understand that posting to social media sites means that those sites’ terms and conditions govern the use and retransmission of the content posted, rather than CMA’s terms and conditions.
  2. CMA has relationships with other entities for the republication, use and distribution of its materials and your permission extends to these other entities for CMA purposes.
  3. You grant permission to CMA to use your name, title and affiliation in conjunction with the testimonial(s).

You understand that you cannot revoke your permission once the testimonial(s) have been published in print or electronic form.

You further understand that CMA will not pay you for the right to use your testimonial.

I have read and fully understand the intent and purpose of this consent and release, and have checked off the box on the evaluation form reflecting my agreement or withholding of my consent.

Sept 2014