Please read below, fill out, and sign this form before your scheduled conversation time. Thank you!
MEDIA RELEASE
Green Streets Initiative, a Massachusetts 501c3 non-profit organization with offices located at 166A Elm St, Cambridge, MA 02140 desires to interview and record such interview for a project that illustrates how real individuals think about their transportation and commuting choices, so others can learn from them about how to make similar choices.
For the intangible value I will gain by participating in the interview and other good and valuable consideration, the receipt and sufficiency of which I hereby acknowledge, I hereby give Green Streets Initiative, their licensees, successors, legal representatives, and assigns, including the City of Everett Planning Department the absolute and irrevocable right and permission to use my name and to use, reproduce, edit, exhibit, project, display, copyright, publish and/or resell photography images and/or moving pictures and/or videotaped images of me with or without my voice, or in which I may be included in whole or in part, photographed, taped, videotaped, and/or recorded on the date signed below and thereafter, and to circulate the same in all forms and media for art, advertising, trade, competition of every description and/or any other lawful purpose whatsoever. I also consent to the use of any printed matter in conjunction therewith.
I hereby waive any right that I may have to inspect and/or approve the finished product or products or the editorial, advertising, or printed copy or soundtrack that may be used in connection therewith and any right that I may have to control the use to which said product, products, copy and/or soundtrack may be applied.
I hereby release, discharge and agree to save Green Streets Initiative, their licensees, successors, legal representatives and assigns from any liability by virtue of any blurring, distortion, alteration, optical illusion or use in composite form whether intentional or otherwise that may occur or be produced in the making, processing, duplication, projecting or displaying of said picture or images, and from liability for violation of any personal or proprietary right that I may have in conjunction with said pictures or images and with the use thereof.
I have read this agreement before signing and fully understand its contents.
