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Multimedia Rights Release

Iirrevocablyconsenttoandauthorizetheuse,reproductionandpublicationbyWesternCuyahogaAudubon
Society,4310BushAve.,Cleveland,OH44109inanymediumofallformsofmediacontentasindicated
bymeinthisMediaReleaseForm.
Ialsoauthorizetheuseofmynameor,ifIchoose,afictitiousname,inconnectionwiththese
photographs/recordingsandacknowledgeWesternCuyahogaAudubonSociety'srighttocopyrightthese
materials,withoutcompensationtome.
IdoexpectWesternCuyahogaAudubonSocietytocontactmeintheeventmyimage/recordedinterviewor
performanceisneededforapurposeotherthanthoseoutlinedbelow.
Allnegatives,positives,andprintsofphotographsinwhichmyimageappears,andallaudioandvideo
recordingsproducedunderthetermsofthisreleaseshallconstituteWesternCuyahogaAudubonSociety's
solepropertyorthatoftheagencythatrepresentsWesternCuyahogaAudubonSociety.
WesternCuyahogaAudubonSocietyhastherighttoassignallrightsgrantedtoWesternCuyahoga
AudubonSocietybythisrelease.
IreleaseWesternCuyahogaAudubonSocietyandthepublishersofthephotographs(andimagesmade
fromthosephotographs)thisdayfromallclaims,includingbutnotlimitedtoclaimsfordamagestomy
reputationorrightofprivacyresultingfrompublicationofthephotographs.

Copyright Western Cuyahoga Audubon Society

Creative Commons 3.0 Attribution-Noncommercial-No Derivative Works.
Western Cuyahoga Audubon, 4310 Bush Ave, Cleveland, OH 44109
Email:
info@wcaudubon.org
Web:
http://www.wcaudubon.org

Datemm/dd/yr
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FirstName
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_______________________________________________________
LastName
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_______________________________________________________
Primaryemail
*
_____________________________________________________
AddressLine#1
*
___________________________________________________
AddressLine#2
*
___________________________________________________
City
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State
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ZipCode
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Phonenumber
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Media Types
*
By checking the boxes below, I have given my consent to the use of the corresponding type of media
content.
Documents ________________________________
Photograph(s) _____________________________
Videotaped interview/performance(s) including transcripts thereof ________________________
Audio taped interview/performance(s) including transcripts thereof _______________________

Redstardenotesrequiredanswer.

Copyright Western Cuyahoga Audubon Society

Creative Commons 3.0 Attribution-Noncommercial-No Derivative Works.
Western Cuyahoga Audubon, 4310 Bush Ave, Cleveland, OH 44109
Email:
info@wcaudubon.org
Web:
http://www.wcaudubon.org

Do you agree to the above terms?

*
Yes, I have read the release and agree to the terms outlined above.
Yes _____________________________

Signature______________________________________________
Name(print)_____________________________________________
Date__________________________________________________

Pleasesendacourtesyemailto
wcaudubon@gmail.com
affirmingyouhavemailedyour
completedformviatheU.S.PostalServiceto:

WesternCuyahogaAudubon,4310BushAve,Cleveland,OH44109
Thank You!
Western Cuyahoga Audubon

Copyright Western Cuyahoga Audubon Society

Creative Commons 3.0 Attribution-Noncommercial-No Derivative Works.
Western Cuyahoga Audubon, 4310 Bush Ave, Cleveland, OH 44109
Email:
info@wcaudubon.org
Web:
http://www.wcaudubon.org