Location: San Diego, CA
Date: April 30, 2013
I hereby authorize the American Foundation for Suicide Prevention (“AFSP”), Chaucerbury Corp., and Omni Video Creations (“Producers”) to record my name, likeness, image, voice, and performance on film and tape (the “Footage”) for multiple and varied uses by AFSP, including but not limited to its website, social media outlets, DVD’s, and other means of print, electronic, and digital communication (the “Project”).
I agree that the Footage may be edited and otherwise altered at the sole discretion of the Producers and used in whole or in part for any and all broadcasting, audio/visual, and/or exhibition purposes in any manner or media, in perpetuity, throughout the world. I understand that I have no rights to the footage or any benefits derived therefrom.
I consent to the use of my name, likeness, voice, and biographical material about me in connection with the promotion of the Project.
I represent that I have the right to enter into this agreement (the “Agreement”) and that my performance and the rights I have granted in this Agreement will not conflict with or violate any commitment or understanding I have with any other person or entity.
I agree to indemnify and hold harmless Producers from and against all claims, losses, expenses and liabilities of every kind including reasonable attorney’s fees arising out of the inaccuracy or breach of any provision of this Agreement. I expressly release Producers from any and all claims arising out of the use of the Program.
This Agreement represents the entire understanding of the parties and may not be amended unless mutually agreed to by both parties in writing.
American Foundation for Suicide Prevention
120 Wall Street, 29th Floor
New York, NY 10005