GeekGirlCon Photo/Model Release Form

I hereby irrevocably authorize GeekGirlCon to use photographs, video and / or digital media of me and / or my property and authorize GeekGirlCon and their assignees, licensees, legal representatives, and transferees to use and publish (with or without my name, company name, or with a fictitious name) photographs, video, audio, portraits, or images herein described in any and all forms and media and in all manners including composite images or distorted representations, and for purposes of publicity, illustration, commercial art, advertising, publishing (including publishing in electronic form on CDs or internet websites), for any product or services, or other lawful uses as may be determined by the photographer, videographer or GeekGirlCon in perpetuity. I further waive any and all rights to review or approve any uses of the images or video, any written copy or finished product.

DESCRIPTION OF MEDIA: General around-the-con images, presentations for broadcast over internet and streaming services, and media featuring the below signed and their work. Images will be used online and in promotional printed materials, as well as promotional videos, on-demand content and streaming content for digital shows.

I HAVE READ AND UNDERSTAND THE ABOVE PHOTO / MODEL RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED BY THEIR SIGNATURES BELOW. I ACCEPT:

E-SIGNATURE:(Required)

EMAIL:(Required)

DATE:(Required)

Agree to Electronic Signatures(Required)

I agree

Each party agrees that this Release may be electronically signed, and that any electronic signatures appearing on this Release or such other documents are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility. To opt-out of an Electronic Signature do not check this box and contact your GeekGirlCon representative for a printable copy of this Release.

Are you signing on behalf of a minor?

Yes, I am the parent or legal guardian of the above-mentioned minor and have legal right and authority to execute the above release on behalf of the minor.

PARENT/GUARDIAN E-SIGNATURE:

PARENT/GUARDIAN EMAIL:

PARENT/GUARDIAN DATE: