I do hereby give my written consent to Pennie, 312-318 Market Street, Bowman Tower, 3rd Floor, Harrisburg, Pennsylvania, to use my image and/or voice for slide or film/video tape purposes including the use of said images on television, world wide web, and in magazines,newspapers, or other digital or print media, periodicals, flyers, or other marketing sources, wherever, whenever, and in whatever manner they shall desire, consistent with good taste which will not be derogatory, degrading or detrimental to me in any way. I understand that Pennie’s publication of my image and/or voice may result in third parties receiving a license to use my image and/or voice and consent to the grant of such licenses. I further understand that I will not receive any compensation, neither now nor in the future, for the above.

This form cannot be submitted for a minor child. A minor child is defined as a child under the age of eighteen (18) years of age.

This Consent Agreement (hereinafter “Agreement”) has been approved as to form and content by the Commonwealth of Pennsylvania. No signatures by the Commonwealth shall be affixed to this agreement, nor shall any wet handwritten signature be required for this Agreement to be legally enforceable notwithstanding a contrary requirement in any law or regulation. By voluntarily entering your name and today’s date below and submitting the form, you are certifying that you read and accepted this Agreement, you are entering into a binding Agreement with Pennie, the affirmation of which will be considered your electronic signature as to the date and time such affirmation was made. You agree your electronic signature is the legal equivalent of your wet signature on this Agreement. By entering your name, today’s date, and submitting this form, you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a keypad, mouse, or other device to select an item, button, icon or similar act/action, or to otherwise access or make any transaction regarding any agreement, acknowledgement, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as “E-Signature”), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third-party verification is necessary to validate your E-Signature and that the lack of such certification or third-party verification will not in any way affect the enforceability of your E-Signature on this Agreement or any resulting contract between you and the Pennsylvania Health Insurance Exchange Authority. You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Agreement. You further agree that each use of your E-Signature constitutes your agreement to be bound by the terms and conditions of this Agreement, any policies and procedures adopted by the Pennsylvania Health Insurance Exchange Authority, and Federal and State Law.

The parties hereby agree not to contest the validity or enforceability of this Agreement executed electronically, or acknowledgment issued electronically, under the provisions of a statute of frauds or any other applicable law relating to whether certain agreements be in writing and signed by the party bound thereby. Any genuine agreement or acknowledgment executed or issued electronically, if introduced as evidence on paper in any judicial, arbitration, mediation, or administrative proceedings, will be admissible as between the parties to the same extent and under the same conditions as other business records originated and maintained in documentary form. Neither party shall contest the admissibility of copies of a genuine agreement or acknowledgments under either the business records exception to the hearsay rule or the best evidence rule on the basis that the agreement or acknowledgment were not in writing or signed by the parties. An agreement or acknowledgment shall be deemed to be genuine for all purposes if it is transmitted to the location designated for such documents.