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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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