This form must be completed by each individual appearing in or involved with the video.


I hereby grant permission to the rights of my image, likeness, and sound of my voice as recorded on audio or video tape to the American Lung Association, Wyoming Department of Health, and U.S Environmental Protection Agency. I understand that my image, likeness, or sound of my recorded voice may be edited, copied, exhibited, published, or distributed. I waive the 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 my image, likeness, or sound of my recorded voice. I also understand this material may be used in diverse educational or promotional settings within an unrestricted geographic area. I release any and all claims against any person or organization utilizing this material.
I understand this permission signifies that photographic, audio, or video recordings of me may be electronically displayed via the Internet or in the public educational setting. Photographic, audio, or video recordings may be used for the following purposes:
• Educational or promotional uses on the internet
• Conference presentations
• Informational presentations
• Other promotional events

I understand I will be consulted about a use for any purpose other than those listed above.
There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.
This release applies to photographic, audio, or video recordings collected as part of the 2022 Wyoming Radon Video Contest only.