I. OWNER INFORMATION
1. Name(s) / 2. Email
3. Address / 4. Cell Phone
5. Home Phone
II. AGREEMENT
1. I, [insert name(s)],
own the item(s) described below and/or have full legal authority to dispose of them. I hereby voluntarily and unconditionally grant to the Civil Air Patrol (CAP) a non-exclusive, world-wide, royalty-free,perpetual and irrevocable right and license to copy, distribute, display, sell, use, publish, and perform certain materials described below, in whole or in part, and to incorporate said materials, in whole or in part, into derivative works for CAP’s use, including, but not limited to, reproduction and distribution in CAP’s printed and electronic materials and posting of the materials on CAP websites.
I affirm that I have full right, power and authority to grant these rights to CAP and that said rights do not violate any rights of any third party. I certify that I have received no goods or services in consideration for these permissions. Furthermore, I relinquish for myself, my descendants, distributors, agents, or personal representatives, all claim to compensation for the use or disposition of these materials, both now and in future, by CAP.
I understand that I retain all right, title, and interest in the materials below, without limitation, including copyright. CAP will own the copyright of any derivate works created by CAP.
I do not object to my name appearing as owner in connection with this property in CAP records, publications, or other descriptions.
1. Owner Signature / 2. Date
III. DESCRIPTION OF PROPERTY LICENSED
Description may continue in section V on the reverse of this form. Attach as many copies of the reverse as necessary.
1. Number of Continuation Sheets Attached:
2. Description
IV. RECEIVED ON BEHALF OF THE CIVIL AIR PATROL BY (staff use only)
1. Name / 2. Duty Position / 3. CAP ID
4. Unit Historical Repository Accepting the Intellectual Property Rights
5. Accession Number / 6. Unit Charter Number
7. Signature / 8. Date
Continuation Sheet of
V. CONTINUED DESCRIPTION OF PROPERTY LICENSED
Attach as many continuation sheets as necessary to adequately describe the property.
1. Accession Number: (staff use only)
2. Description Continuation
CAPF 181, 23 DEC 15 OPR/ROUTING: HO