Cart – IMPACT Learning Institute

IMPACT Learning Institute and IMPACT Access Fund (“Course Provider”) desire to electronically record speaker’s video presentation, participation, and/or interview (“Recording”) from programming sponsored and/or hosted by IMPACT Learning Institute.

Speaker/Presenter hereby grants Course Provider the right to use his or her name, voice, appearance, likeness, image, words, participation and title or professional designation, as such may be embodied in the Recording and any pictures, photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf of the Course Provider.
Speaker/Presenter agrees that Course Provider has complete ownership of the Recording, pictures, etc., including the entire copyright, and may use them for any purpose consistent with the mission of the Course Provider. These uses include, but are not limited to illustrations, bulletins, exhibitions, videotapes, reprints, reproductions, publications, advertisements, and any promotional or educational materials in any medium now known or later developed, including the Internet. Course Provider may edit the recordings at its discretion.
Speaker/Presenter acknowledges that they will not receive any compensation for the use of the Recording, pictures, etc., and hereby release Course Provider and its agents and assigns from any and all claims which arise out of or are in any way connected with such use.
Speaker/Presenter upon written request to Course Provider, shall be provided with a copy of his or her Recording in electronic format.
If the Course Provider uses any content in which Speaker/Presenter appears outside of the original course in which the Speaker/Presenter was featured, Course Provider will submit such content to the Speaker/Presenter for approval prior to release.
This Release shall be governed in accordance within the laws of the State of California, constitutes the entire agreement of the parties and may be amended only in writing. Please indicate your understanding, agreement and consent to the terms of this Release by signing in the space provided below.

Speaker/Presenter Information

Legal Name*

First Last

Email*

Phone*

*

I have read and understood this consent and release and hereby agree to its terms.

*

I acknowledge that IMPACT will be the copyright owner of the Materials and my image, voice and/or likeness becomes the sole and exclusive property of IMPACT, and that IMPACT may sell, copy, modify, create derivatives, license, assign, transfer, archive and otherwise use my image, voice and/or likeness in any Material. I further authorize IMPACT to grant any third party the right to use my image, voice and/or likeness for any lawful commercial or non-commercial purpose related to internships, academics or education. I release IMPACT from any and all liability arising out of the use of my image, voice and/or likeness, including without limitation any claims arising out of my right of privacy or right of publicity. I am participating on a voluntary basis and no compensation, fees or royalties will be paid for this use.

*

Upon my written approval of the use of content in which I appear, I give my consent to the Course Provider to use my name, likeness and the Recording to promote the Course Provider, its fiscal agent, and/or their activities and I agree to the terms listed above.

Electronic Signature*

I understand that entering my name below constitutes a legal, binding signature and confirms that I have read and understood this consent and release and hereby agree to its terms.

First Last

Phone

This field is for validation purposes and should be left unchanged.