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Name* This field is required.
First Name
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Location Coordinates If Known
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Phone Number* This field is required.
Area Code
Phone Number
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Email* This field is required.
example@example.com
6
UPLOAD VIDEOS OR PICS
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Information We Might Need To Know* This field is required.
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Signature* This field is required.Granting Rights to Share *I grant permission to Area 52 Media Group, Inc. and its agents and employees the irrevocable and unrestricted right to reproduce the photographs and/or video images taken by me, or members of my family, for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium. I hereby release Grounders TV, Area 52 TV, Area 52 Media Group Inc., and their legal representatives for all claims and liability relating to said images or video. Furthermore, I grant permission to use my statements presented here, or that were given during an interview or guest lecture, with or without my name, for the purpose of advertising and publicity without restriction. I waive my right to any compensation.
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