Media Release Form

Media Release Form
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Conditions
I grant permission to Nudrate LLC, hereinafter known as “Media” to use my image (photographs and/or video) for use in Media including:
videos, email blasts, recruiting brochures, newsletters, magazines, general publications, social media, websites and other Nudrate documents.

I hereby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from related to the use of the image.
Please agree to the paragraph below*

I am 20 years or age or older and I am competent to contract in my own name. I have read this release before signing below, and I fully understand the contents, meaning and impact of release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.
Signature

Powered by Jotform SignClear
Should be Empty: