Photograph, Audio & Video Release Form

I hereby grant permission to the rights of my image, likeness and sound of my voice as recorded on audio or video tape without payment or any other consideration.  I understand that my image, likeness and sound may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording.  I also understand that this material may be used in diverse entertainment and educational settings within an unrestricted geographic area through various media presently utilized or yet to be created.

Photographic, audio or video recordings may also be used for the following purposes:

• music videos
• audio recordings
• educational videos
• conference presentations
• informational presentations
• on-line courses and presentations
• educational presentations or courses

By signing this release I understand this permission signifies that photographic, audio or video recordings of me may be electronically displayed via the Internet or in the public setting.

I will be consulted about the use of the photographs or video recording for any purpose other than those listed above.

There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.

This release applies to photographic, audio or video recordings collected as part of the sessions listed on this document only.

By signing this form I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for the above stated purposes.

If this release is obtained from a presenter under the age of 18, then the signature of that presenter’s parent or legal guardian is also required.

Signature and Email

1. Name
2. Email
3. Submit

Thank you for your submission!