Diversity Access Pipeline, Inc.'s Journey to Esquire®️ Scholarship & Leadership Program Photo Release Form

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Please complete this form so that we can use your image and likeness on our social media and in our publications. You must agree to all of the following to participate in the Program.

Email *

I hereby grant Diversity Access Pipeline, Inc. (the Company), Journey to Esquire®️, and its affiliates and assigns permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration. *

Yes

I understand and agree that all photos will become the property of the Company and will not be returned. *

Yes

I hereby irrevocably authorize the Company to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any 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 the photo. *

Yes

I hereby hold harmless, release, and forever discharge the Company from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. *

Yes

I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE. I ACCEPT BY WRITING MY NAME BELOW. *

Today's date *

YYYY

A copy of your responses will be emailed to the address you provided.

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