ICPA, INC.  PHOTOGRAPHY/VIDEOGRAPHY RELEASE FORM (PERPETUAL)

 

SUBJECT: _________________________

For valuable consideration, receipt of which is hereby acknowledged, I grant to ICPA, Inc its legal representatives, licensees, parent, affiliates, assigns, transferees and employees the absolute worldwide right and permission to photograph, record, video, copyright, use, re-use, publish, and re-publish photographic/video portraits, pictures or images of me and my property or any likeness of me or in which I may be included, in whole or in part, or composite or distorted in character or form, without restriction as to changes or alterations, in conjunction with my own or a fictitious name, or reproductions thereof in color or otherwise, made through any medium, conventional or digital and in any media now or hereafter known.  The photographs/videos may be used for the purposes of promoting ICPA, Inc, including web, illustration, publicity, promotion, art, advertising, or trade, with or without my name.  This authorization is perpetual in nature and will not expire.
 
I hereby release and discharge ICPA, Inc. parties from any and all claims for damages for libel, infringement of the right of publicity, invasion of privacy, portrayal in a false light, or any other claim based on use of the above-described material(s).

Any disputes over the formation, validity, construction and performance of this Agreement are subject to U.S. law and the model agrees to submit to the personal jurisdiction of courts in the United States of America.

I hereby warrant that I am of full age and have the right to contract in my own name and I have the full capacity, power and authority to grant this release.  However, if I am a minor, my parent or guardian has reviewed the above Agreement and consents to the above on my behalf.  I (or my parent or guardian) have read and understand the above authorization, release and agreement.  This release shall be binding upon me and my heirs, legal representatives, and assigns.

Date:
Signature:
Printed Name:
Address:
Signature of Parent or Guardian:
Printed Name: