CONSENT AND RELEASE FORM
I hereby irrevocably grant in perpetuity to the American Cancer Society
Cancer Action Network, Inc., its legal representatives or assigns,
affiliates (including, but not limited to, its separately incorporated
divisions, the American Cancer Society, Inc., ACS Products, Inc., and the
American Cancer Society Foundation) and those acting under its permission
and upon its authority, or those for whom American Cancer Society Cancer
Action Network, Inc. is acting, the absolute right and permission to:
(a) copyright, use, re-use, publish, and republish, and to license the
right to use, re-use, publish and republish, photographic portraits or
pictures of me or in which I may be included intact or in part, composite
or distorted in character or form, in any medium or form of distribution
without restriction as to changes or transformations in conjunction with my
own or a fictitious name, or reproduction hereof in color or otherwise,
made through any and all media now or hereafter known for any purposes
whatsoever, including, without limitation, illustration, art, promotion,
advertising or trade;
(b) copyright, use, re-use, publish and republish, and to license the right
to use, re-use, publish and republish my likeness and/or voice on film or
videotape, to edit or change or alter such recording(s) at its sole
discretion in which I may be included in whole or in part, or composite or
distorted in character or form, in any medium or form of distribution
without restriction as to changes or transformations in conjunction with my
own or a fictitious name, or reproduction hereof in color or otherwise,
made through any and all media now or hereafter known for any purposes
whatsoever, including, without limitation, illustration, art, promotion,
advertising or trade; and/or
(c) copyright, use, re-use, publish and republish, and to license the right
to use, re-use, publish and republish my testimonial (written) and edit
such testimonial in its sole discretion, in any medium or form of
distribution without restriction as to changes or transformation in
conjunction with my own or a fictitious name, made through any and all
media now or hereafter known for any purposes whatsoever, including,
without limitation, illustration, art, promotion, advertising or trade.
It is my understanding that I will receive no compensation for my likeness
or testimonial.
I hereby waive any right that I may have to inspect and/or approve the
finished product or the advertising copy or printed matter that may be used
in connection with my likeness or testimonial or the use to which it may be
applied.
I agree that I have no rights to the photographs, reproductions, negatives,
videos or films, and all rights to such materials belong to American Cancer
Society Cancer Action Network, Inc.
I hereby release, discharge and agree to save harmless American Cancer
Society Cancer Action Network, Inc. and its employees or agents,
affiliates, legal representatives or assigns and all persons acting under
its permission or upon its authority or for whom it is acting, from any
liability by virtue of any publication of my likeness or testimonial,
including, without limitation, claims for libel or invasion of privacy, as
well as any liability arising by virtue of any blurring distortion,
alteration, optical illusion of use in composite form, whether intentional
or otherwise, that may occur or be produced in the making of such picture
or recording(s) or in any processing tending towards the completion of the
finished product.
I hereby warrant that I am of full age and have every right to contract in
my own name in the above regard. I state FURTHER that I have read the above
AUTHORIZATION and release prior to its execution, and that I am fully
familiar with the contents thereof. This agreement shall be binding upon me
and my heirs, legal representatives and assigns.
[FOR MINORS ONLY] If you are under 18 years of age, your parent or legal
guardian must sign this Consent and Release Form and provide the
information requested below. I certify that I am the parent or legal
guardian of the individual submitting this content and I agree that I have
read this document completely before agree to its terms and conditions and
I understand its contents.