Media Release

I, Your Name (required):
hereby irrevocably consent to and authorize the reproduction, publication and any other use
by Macrodo, its licensees and assigns, of the photographs, audio, video identified below, in
whole or part in conjunction with other media, in any medium and for any lawful purpose,
including illustration, promotion, advertising or web content, without any royalty or
compensation to me.

I assign to Macrodo any and all rights of ownership to the photographs, audio, video,
the transparencies, or digital files thereof, and agree that Macrodo has full right to copyright,
use and publish the same in print and/or electronically, with full right of lawful disposition in
any manner.

I waive any right to notice, inspection, or approval of any use of the photographs/audio/
video which the Macrodo, may make or authorize, and I release, the Macrodo, and its licensees
and assigns, from any claim or liability arising from or in connection with Macrodo’s  use of the
photographs, audio, video or any alteration, processing or use thereof in composite form,
whether intentional or otherwise.

Type of Media being released to Macrodo:


 
Description(s): 
                         
 

INDIVIDUAL:

 
I am over twenty-one years of age.  I have read and understand the above.
 
Signature:

Address:

Phone:

Email: (required)

 

FOR MINOR:

 

I am the parent/guardian of the individual named above, my name is 

I have read and understand the above. 

I consent to the foregoing on his/her behalf on today's Date:  
 
On behalf of the individual (named above):

I Agree:
*By selecting this box you agree that all information supplied on this form is true and you agree to release media to Macrodo for use in a project.