Be Spotlighted as a Community Leader

I do hereby permit and authorize the Ohio Access to Justice Foundation (hereafter “Foundation”), its agents and/or vendors, to interview, photograph, film, videotape and/or record my likeness and voice (hereafter collectively “Media Material”).

I acknowledge, understand, and agree that this Media Material along with my name and biographical information may be used for training or publicity purposes, and/or may be published in mass media or legal publications; on the Foundation’s website, www.ohiojusticefoundation.org; on YouTube, or may be used in other training, fundraising, public relations or communications activities to benefit the Foundation or any of the Foundation’s grantees. I do not hold the Foundation responsible for the unauthorized use of images or information, including images or information taken from printed materials or electronic/social media – in whole or part – by third parties.

I further acknowledge and agree that this Authorization and Release is given without compromise and that I shall not receive any compensation for the use of the Media Material as outlined above. I further acknowledge and agree, that the Media Material including any and all raw footage, becomes the property of the Foundation.

I hereby release, acquit, and forever discharge the Foundation, its current board members, agents, officers, and employees from any and all claims, demands, rights, promises, damages and liabilities arising out of or in connection with the use or distribution of Media Material, including but not limited to any claims for invasion of privacy, appropriate of likeness or defamation. This release is binding on me and my heirs, assigns and personal representatives. Further, this release is effective until revoked in writing by the undersigned. Such revocation shall only be effective to prevent any future use of the materials.

I HAVE READ AND FULLY UNDERSTAND THE ABOVE PROVISIONS AND AGREE TO BE LEGALLY BOUND BY THEM AS INDICATED BY THE CHECKBOX ABOVE.