Thank you for allowing your likeness to be used in support of ESRAG (Environmental Sustainability Rotary Action Group). To assure we give you proper credit and record your permission, please complete the following Photo Release Form.  

Your privacy is important to ESRAG and the personal data you share with us will be used only for official ESRAG business. Personal data will be used to identify you and verify your permission.  This document will be copied and stored electronically in ESRAG’s archives.  Personal data collected from this form is subject to ESRAG’s Privacy Policy (rotary.org/privacy).

1. I grant to ESRAG and their agents, contractors and representatives permission to record my name, image, voice, statements, personal story and biographical or personal information (collectively “Likeness”) as well as materials, including presentation materials, written materials, photographs or videos collected by or provided to ESRAG (collectively “materials”) by video, audio recording, photograph, motion film, note-taking, interview and other recording (“Recordings”).

2. I understand that ESRAG will be the exclusive, perpetual, worldwide owner of all rights including, copyright, title and interest in and to the Recordings. I understand ESRAG will have the rights to use, copy, display, print, publish, reproduce, edit, exhibit, distribute, adapt, publicly perform, broadcast, stream, webcast, transcribe and prepare derivative works of the Recordings, which include my Likeness and materials, in whole or in part, for any purpose whatsoever, in any medium, form or technology now existing or hereafter developed, including in publications, via streaming, on social media, any ESRAG webpage,  in photography or virtual reality exhibits, news stories, reports and for promotional and marketing purposes. I agree that ESRAG shall have the worldwide, perpetual right to license use of the Recordings, which include my Likeness and materials, including, but not limited to, the media, ESRAG licensees, partners, club members and researchers and the public for educational purposes.

3. I agree that ESRAG may retouch my Likeness in the Recordings, edit any bio I provide to ESRAG, and that I have no right to inspect and/or approve the Recordings or any use of the Recordings or any editorial material used with the Recordings. I hereby release ESRAG from all liabilities and damages related to the making of and use of the Recordings and use of my Likeness and materials and warrant that my materials will not infringe upon or violate any rights of any person or entity. By signing this Release, I warrant that I have the right to grant the rights and licenses set forth in this Release. I understand and agree that the permissions and licenses I grant in this Release are royalty free and that I have no right to payment. I acknowledge that this Release is governed by State of Illinois, USA law and nothing herein may be construed to make me an agent or employee of Rotary or ESRAG. I have read and understand this Release and understand that this Release shall be binding upon my heirs and assigns.

4. If the subject of this release is a minor, below the age of eighteen (18), I warrant that I am their parent or guardian of that minor and that I am authorized to make this release on their behalf.

Thank you for completing this form.  If you have any questions about participating in this event, please contact the event organizer