University of Maine System and Cooperative Extension Media Release Agreement - Plugged In: For UMaine Extension Staff and Volunteers

Date*

Name (of person in photo/video)*

First Last

Email*

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Address*

Street Address Address Line 2 City State ZIP Code

County*

Phone*

TERMS OF ACCEPTANCE

I hereby grant and authorize the University of Maine System, acting through the University of Maine, (hereinafter UMS) its employees and agents to make use of, license or assign the use of, my image, appearance, likeness, voice and/or photograph, and other reproductions of any of these, in still photographs, videotapes, publications, audio, sound recordings, web sites, electronic and other media and/or motion pictures, (hereinafter all of which are included in the term “Material”) and to do so with or without mention of my name.

I understand and agree that I am to receive no compensation of any kind, monetary or otherwise, on account of or arising from the production, publication, recording, rebroadcasting, or other use of such Material.

UMS shall have complete ownership of the Material produced or published and shall have the exclusive right and license to make such use of that Material as it wishes, including, but not limited to the right of performance, display, reproduction and distribution in all media, and the right to create, perform, display and distribute derivative works of the Material.

I agree to indemnify and hold UMS, the University, its employees and agents, harmless from and against any and all claims, damages, lawsuits, judgments, and expenses, including reasonable attorneys’ fees, that UMS may become liable to pay or defend arising out of or caused by any matter or material furnished or spoken by me in connection with my appearance.

I hereby release UMS, its employees and agents from all expenses, claims and liabilities incurred by me arising out of or in connection with my appearance and/or the use of the Material, except to the extent that those expenses, claims or liabilities are the direct result of the negligent acts or omissions of UMS, the University, its employees or agents.

This agreement shall be governed and construed according to the laws of the State of Maine.

NOTE: If under 18, must be signed by parent or guardian on last checkbox below.

SIGNATURE

I, the undersigned for this media release form, warrant the truthfulness of the information provided in this application.

Electronic Signature:*

Please type your First and Last Name

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

Electronic Signature of Parent or Guardian (if applicable)

Please type your First and Last Name

I, as Parent/Guardian, understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

NOTE: If the Submit Button is not displaying here, go back to the County dropdown menu and select your county of residence.

Email

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