Video Talent Release Form printable pdf download

Video Talent Release Form

USACS “Best in Medicine” Video Challenge

Production For:

________

_______________________

Date:

Residency Program:

Name of Producer: _____________________ E-Mail: _____________________________

____________________________________________________

Address:

_________________________

_____________________

Phone:

Signature:

I, the undersigned, appear in the above-identified Production in connection with the USACS “Best in Medi-

cine” Video Challenge, and I hereby grant to USACS Management Group, Ltd. and its affiliated and related

companies, agents and assigns (collectively “USACS”), the absolute right and permission to use, modify, copy,

distribute, broadcast , publish and display any and all photographs, audio recordings, digital images or video

images of me, my voice or my likeness included in the Production for any commercial and non-commercial

purposes. I understand that I will receive NO monetary compensation for the use of said images, sounds or

likeness. I agree that the photographs, audio recordings, digital images or video images are solely owned by

USACS and irrevocably release USACS from any and all claims or liability, known and unknown, of any nature

or kind, arising out of the use of said photographs, audio recordings, digital images or video images.

Signature: ________________________________________________________________

Print Name: _____________________________________________________________

Phone Number: __________________________________________________________

Address: _______________________________________________________________

_______________________________________________________________________

________________________________________________________________________

Please submit additional copies for additional participants. The information provided will not be distributed or

used for any purpose other than to keep on file for record of legal release by the participants. Thank you.

Please upload with video submission.

Questions? E-mail us at

Video Talent Release Form