JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Submit Your Videos to "Fury Road" channel
Fill out the form & get featured! [PLEASE ONLY SUBMIT VIDEOS THAT YOU OWN]. This basic agreement below permits Fury Road channel to feature your content and protect our work from incorrect copyright claims. The video still remains the property of you and allows us to still use it if you license your clip.
Please provide a time stamp (example 07:15) if it is a long video and some additional info.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Your Full Name
*
For Example - John Smith
Your answer
Your YouTube Channel Name
*
For example -
www.youtube.com/channel/your_channel_name
Your answer
Email Address
*
For Example -
your_email@gmail.com
Your answer
Content Category
*
Choose
Road rage
Instant karma/Justice
Truck Crash
Car crash
Hit & Run
Other
YouTube Video Link
*
Direct link to your video on youtube
Your answer
Additional YouTube Video Link #1 (For a different video - Optional)
Your answer
Are you the original copyright owner of the video?
*
Yes
No
Comments/Time of Incident
Tell us the context of incident. What's happening, when and where, etc.
Your answer
AGREEMENT
*
This agreement is for the purpose of disputing any copyright claims that may arise in the future if somebody sells their video.
I hereby acknowledge that I either directly own or own distribution rights to all content submitted. By submitting this video to
www.youtube.com/FuryRoad
, I hereby acknowledge emitting all rights of use to "Fury Road" to feature the footage on the channel Fury Road (
https://www.youtube.com/furyroad
) and thus grant Fury Road a perpetual non-exclusive world-wide license (not ownership) to display, promote, or modify my content for commercial use on Youtube and Social Media platforms. I also stand liable to legal action if I do not have the necessary rights of ownership/distribution of the content submitted.
Required
Date
*
Date of submission
MM
/
DD
/
YYYY
Signature
*
Typing your name serves as your digital signature for this agreement
Your answer
Are you over the age of 18 years old?
*
Yes
No
Your Legal Guardian's Signature
*
If Under the Age of 18 we are required by law for your legal parent or guardian to also sign this agreement
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
