Member Registration And Photograph And Video Release Forms

PEDAL Photograph and Video Release

I hereby grant permission to the rights of my image, likeness and sound of my voice as recorded on audio or video tape without payment or any

other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or

approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to

the use of my image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted

geographic area.

By signing this release I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the

Internet or in the public educational setting.

There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.

This release applies to photographic, audio or video recordings collected as part of the sessions listed on this document only.

By signing this form I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby

release any and all claims against any person or organization utilizing this material for educational purposes.

Name (Printed): _______________________________________________________________________________________

Signature: __________________________________________________________________ Date: ____________________

I have read and agree to the terms above

If this release is obtained from a member under the age of 18, then the signature of that presenter’s parent or legal guardian is also

required.

Minor’s Name (Printed): ___________________________________________________ Birth Date of Minor: _____________

Guardian/Parent Signature: _____________________________________________________ Date: ___________________

I have read and agree to the terms above

Mail both forms and your ($15.00 for member or $25.00 for families) annual membership dues to:

PEDAL, P.O. Box 2141, Loveland, CO 80539-2141

Member Registration And Photograph And Video Release Forms - Pedal Club Page 2