Teri Bybee's Women's Leadership Forum

Video & Photo Release Form

I hereby grant and authorize Teri Bybee and the "Women Who Risk" organization the following privileges for the purpose of recording a Zoom video meeting in which I have been invited to participate: the right to take, copy, exhibit, publish, distribute and make use of any and all broadcasted live video taken of me to be used in and/or for the furtherance of the goals of the "Women Who Risk" organization.

I consent to the editing of said video only if the edited segment does not misrepresent or alter my expressed viewpoint.

I waive any right to royalties or other compensation arising or related to the use of the video.

I hereby hold harmless and release Teri Bybee and "Women Who Risk" from all liability, petitions, and causes of action which I, my heirs, representative, executors, administrators, or any other persons may make while acting on my behalf or on behalf of my estate.

This authorization extends to all languages, media, formats and markets now known or later discovered; and shall continue indefinitely, unless I otherwise revoke this authorization in writing.
Yes, by checking this box
I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby.
No, by checking this box
I am acknowledging I do NOT want my image or likeness to be published or used in any marketing materials. I acknowledge that I understand the event will still be recorded, however portions of audio or video in which I participate will not be used.
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