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I hereby authorize to The Medical Society of Virginia Insurance Agency, The Medical Society of Virginia, and the agents and representatives of each organization, the absolute right and permission to use or disseminate the following information, in whole or in part. I hereby authorize the use and dissemination of the materials referenced above without prior inspection or approval of the finished product, the advertising copy, or the use to which it may be applied. I hereby release from liability all of the entities referenced above, together with their agents and representatives for the use or dissemination of the materials referenced above. I understand that I may be identified as the source of the content and that such use or dissemination will be public in nature.(Required)