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Photo/Video Release

In exchange for good and valuable consideration, the receipt of which is acknowledged as received, I hereby grant the following rights and permissions to the United Shale Advocates (USA) and the Marcellus Shale Coalition (MSC) and those acting with its authority and permission (collectively, “USA/MSC”). I grant the USA/MSC the irrevocable, perpetual and unrestricted right and permission to take, use, re-use, publish, and republish photographic portraits or pictures, as well as video, of me or in which I may be included, in whole or in part, or composite or distorted in character or form, without restriction as to changes or alterations (collectively, “Pictures”), in conjunction with my own or a fictitious name, or reproductions thereof in color or otherwise, and in any and all media now or hereafter known, specifically including but not limited to print media and distribution over the internet for illustration, promotion, art, editorial, advertising, trade, or any other purpose whatsoever. I specifically consent to the digital compositing of the Pictures, including without restriction any changes or alterations as to color, size, shape, perspective, context, foreground or background. I also consent to the use of any published matter in conjunction with such Pictures and/or video. I hereby waive any right that I may have to inspect or approve the finished product or products and the advertising copy or other matter that may be used in connection with the Pictures/Video or the use to which they may be applied. I hereby release, discharge, and agree to hold harmless the USA/MSC from any liability or claims related to or arising from: (i) any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of the Pictures/Videos or in any subsequent processing of them; (ii) any publication of the Pictures/Videos, including without limitation any claims for libel or violation of any right of publicity or privacy; and (iii) damages, royalties, or other payments that may be associated with the MSC’s use of the pictures/video. I hereby warrant that I am of full age and have the right to contract in my own name. I have read the above authorization, release, and agreement, prior to its execution, and I am fully familiar with the contents of this document. This document shall be binding upon me and my heirs, legal representatives, and assigns.

By submitting this form, you agree to these terms & conditions.