ThruOurEyes.org Audio / Video Release Form

Form last updated: 8/1/10

To be able to participate in our show or shows, please read the statements below and, if in agreement, check AGREE where indicated. A copy will be supplied to you upon request.

"I, the undersigned, hereby give to the N.J. National Federation of the Blind Northeast New Jersey Chapter, my permission to use any audio/video or photographic images taken of me from this date, for the “Thru Our Eyes” television show, WTOE Radio Shows and or our website(s). I also understand that this applies to any future NFB Northeast NJ Chapter publications, brochures, and or any other audio/video broadcasts, which are produced by and or for the N.J. NFB Northeast Chapter. I further understand that I will receive no compensation for my participation, now or at any other time; that said audio / video and/or photographic media remains the sole property of N.J. NFB Northeast Chapter; and I have no say or editorial rights to the finished product”.

Your First Name:

Your Last Name:

Date:

Your Email Address (NOTE: this address MUST be the same address as you will enter in our GUEST APPLICATION next)

Which show will you be appearing on?
(Select from drop down list)

By clicking I ACCEPT / AGREE below you are affixing your electronic signature agreeing to the TERMS & CONDITIONS stated on this form. Your email address above must be verifiable and the same address you use to communicate with us. You further state that you have the necessary permission(s) to speak on behalf of the organization/company you are representing (if applicable). And you further understand that your IP ADDRESS will be recorded, kept on file and serve as legal proof of your signature.

ACCEPT TERMS AND CONDITIONS:

I Accept / Agree

No, I do not agree or accept

Confirm that the information you supplied is correct. When you click the SUBMIT BUTTON you will be taken to our GUEST FORM (MANDATORY). Please supply as much information as possible. Note that some entry fields are MANDATORY.