By submiting this form, I authorize USMRA and the hosting club (Synergy Ringsport), to use the following personal information:
(1) My picture - including photographic, motion picture and electronic (video) images.
(2) My voice - including sound and audio/video recordings
I hereby grant USMRA and the hosting club the right to use, publish and reproduce, for all purposes, my name, pictures of me in film or electronic (video) form, sound and video recordings of my voice, and printed and electronic copy of the information described in sections (1) and (2) above in any and all media including, without limitation, cable and broadcast television and the Internet, and for exhibition, distribution, promotion, advertising, press conferences and in brochures and other printed media. This permission extends to all languages, media, formats and markets now known or hereafter devised.