RELEASE FORM
FOR APPEARANCE IN PHOTO, FILM, VIDEOTAPE, MULTIMEDIA OR OTHER IMAGE-BASED PRODUCTION BY OR FOR THE NASA GLENN RESEARCH CENTER
John H. Glenn Research Center at Lewis Field
National Aeronautics and Space Administration
21000 Brookpark Road
Cleveland, OH 44135-3191
Re: DIME Drop Days
To Whom It May Concern:
In consideration of your permitting me to appear in the image(s) or production(s) entitled, DIME Drop Days, and any other image or image-based production to be produced by or for Glenn Research Center, I hereby authorize you, and anyone claiming under or through you, to use and exploit, throughout the world, in any manner or media, my appearance in the image or image-based production and to use my name, voice, likeness and appearance for the purpose of advertising, publicizing and promoting it. I agree that I shall have no right to approve or disapprove of the use made thereof. I agree to comply with all of your requests, instructions and directions relating to my appearance in the image or image-based production. I am familiar with the plot and story line of the image or image-based production, which is basically:
Advertisement and promotion of the NASA GRC Dropping In a Microgravity Environment(DIME) project in printed brochures and electronic images on the World Wide Web.
I understand that out-takes or scenes from the above presentation may be subsequently used in other productions. I agree that I shall not have and I herein specifically waive any claim against you or anyone claming under or through you, for compensation or for defamation, libel, slander, violation of privacy or otherwise (whether of a similar dissimilar nature) resulting from my appearance in the production or the use thereof.
If I am an employee of the Glenn Research Center and/or the National Aeronautics and Space Administration, or any of its contractors or partners, I understand that my participation in the production is not a requirement or condition of my employment and that any refusal on my part to participate will in no way effect my employment.
I represent and agree that I am free to enter into this agreement; that I have not entered into any agreements or commitments inconsistent herewith (and I will not do so); that I am solely responsible for my appearance in the production and for any loss to any party arising therefrom; and that I: am am not (check one) over the age of 18 years. This irrevocable authorization shall commence on the date hereof and shall continue forever.
Participant/parent/guardian Signature (Signed)Participant Name (print)
Address
Telephone
Images and image-based productions will be produced by or for the NASA Glenn Imaging Technology Center.
If the participant is a minor, the parent or guardian must consent to the appearance of such minor as herein above set forth.
C:\Marv\Forms C\ITC Forms C\Model Release.doc (Rev. 16-Aug-00)