Video Release Form

For good and valuable Consideration herein acknowledged as received, and by signing this release, I hereby give Georgetown University my permission to use the Recording, and to license the Recording for use by others, in any media (including digital, electronic, print, television, film and other media now known or to be invented) in perpetuity for all commercial and non-commercial purposes. I agree that the Recording may be combined with other images, text and graphics, and cropped, altered or modified.

I agree that I have no rights in or to the Recording, and all rights to the Recording belong to Georgetown University. I acknowledge and agree that I have no further right to additional consideration or accounting, and that I will make no further claim for any reason to Photographer/Filmmaker and/or Assigns. I acknowledge and agree that this release is binding upon my heirs and assigns. I agree that this release is irrevocable, worldwide and perpetual.

I represent and warrant that I am at least 18 years of age and have the full legal capacity to execute this release.

Name

NetID

Address

City

State

ZIP

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Are you over the age of 18?
Yes No

I have read this form and agree to the terms.
Yes, I agree and release my video for use by Georgetown University. No, I do not agree.

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