PATH Media Release + Emergency Contact Info
Inquiries: Flexie at flexie@pathtohiphop.org or 786-520-0930
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MEDIA/WORK PRODUCT RELEASE
I grant to PATH: Preserving, Archiving & Teaching Hiphop, Inc. and its affiliates, partners, legal representatives, assignees, officers, directors, trustees, employees, agents, and servants (collectively “The Organization”), the right, in perpetuity, to photograph, film, videotape or record my image and likeness (“Image(s)”), and/or my work products ("Creative Assets") to publish, publicly use, display and reproduce the Image(s) or Creative Assets in any format or media (currently existing or to be developed in the future), including but not limited to publication and advertising in print, TV, electronic, internet and other media of every description, in conjunction with the Program and/or The Organization. I acknowledge that I will not be entitled to receive, nor assert a claim for, any fees, payments, royalties, residuals, or any other form of compensation for the use of the Image(s).

All recorded media, prints and created media produced of my likeness shall constitute the property of The Organization.
EMERGENCY CONTACT
Emergency Contact First Name *
Emergency Contact Last Name *
Relationship to you *
Emergency Contact
By listing this person as my emergency contact, I consent to information being shared with this party if it would enable this person to act on my behalf in case of an emergency or my failure to communicate with PATH.
Emergency Contact Phone *
Emergency Contact E-mail
JURISDICTION
I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of
Florida in the United States of America, and this Release shall be governed by and interpreted in accordance with the laws of the State of Florida. I agree that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue to be enforceable.
I consent and agree that my use of a key pad, mouse or other device to sign my name constitutes my signature, acceptance and agreement as if actually signed by me in writing. I further acknowledge and agree that I am competent and authorized to sign this agreement, acknowledgment, consent, terms, disclosures or conditions. I also agree that no certification authority or other third party verification is necessary to validate my electronic signature; and that the lack of such certification or third party verification will not in any way affect the enforceability of my signature or terms of this agreement. *
First Name *
Last Name *
Signature *
Date *
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