We require your permission to use photos and video of you for educational and marketing purposes. Please write your initials below and indicate any limitations.
By initialing below, you agree as follows: For consideration that I acknowledge, I voluntarily give my consent to the videotaping/photographing/audio recording/interview of myself, and I grant to the Chordoma Foundation and its assigns, licensees, and successors the right to copy, use, display, and distribute all or a portion of the recordings, images, and statements thereby obtained in all forms including any composite or derivative representations throughout the world and in perpetuity. I further consent to the use of my name in connection with my image, and I waive the right to inspect or approve use of the above or any related written copy for the purposes described in this consent and release. I understand that material obtained may be used to support the Chordoma Foundation’s mission, including its educational programs, outreach, fundraising, or public relations efforts.
I release the Chordoma Foundation and its assigns, licensees, and successors from any claims that may arise regarding the use of the materials obtained under this consent including any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity, or copyright. I am signing this voluntarily, and acknowledge that I will receive no compensation for the rights granted in this consent and release. The Chordoma Foundation is not obligated to utilize any of these rights.
I have read and understood this form in its entirety, have had the opportunity to ask questions, and agree to be bound by it. I represent that I am of full age and have the right to contract in my own name. This consent and release expresses the complete understanding of the parties.