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WomenTech Role Model Consent Form

I hereby give, convey, and consign to New Traditions for Women (NTW) as donation for such purposes as NTW shall determine, all legal title and interest in copyright of personal and biographical information provided to them and to photographs provided or taken, and most particularly the exclusive rights of reproduction, distribution, and preparation of derivative works, public performance and display. In addition anyone authorized by NTW has the right to copyright, reproduce, publish and otherwise use my information and photograph(s) in any and all media, for purposes of advertising and promoting the services of NTW. I have rights to the photos submitted and these rights do not infringe on the rights of any third party. New Traditions for Women is doing business as the Institute for Women in Trades, Technology & Science.

I acknowledge NTW's right to crop or treat the photograph at its discretion. I also understand that if and when my image is posted on the WomenTechWorld.Org Web site or any affiliated Web site with the express permission of NTW any computer user is able to download the image(s). I therefore agree to indemnify and hold harmless from any claims NTW and it's affiliates . I hereby waive any causes of action I may have on account of the use of my name, information or photograph(s).

I the submitting party acknowledge I am of legal age (eighteen in the United States) to release personal and biographical information as well as photo(s).

I have read and understand the above statements. By signing, I agree to the above conditions.


______________________________
Signature

Print Name: ______________________________ Date: ________________

Please mail this form to:
IWITTS/Consent Form
1150 Ballena Blvd, Suite 102,
Alameda, CA 94501


It is necessary for IWITTS to have a consent form from a role model prior to interviewing her. We can also accept faxed consent forms at 510-749-0500.

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