MEDIA ACCREDITATION PROFORMA
TALISMAN SABER 2013 Media Accreditation
This form acknowledges the accreditation of the media organisation and correspondent whose name/s appear below as a Defence correspondent in the region.
ACCREDITATION OF CORRESPONDENT/S
(Name/s)…………………………………………………………………………………
(Print)
Contact number/s: ……………………………………………………………………………….………….
Name of News organisation…………………………………………………………………………….
(Print)
Authorised by (Name of News Director/Chief of Staff)
…………………………………………………………………………………………….
(Print name, add signature and date)
Contact Details……………………………………………………………………………………
Approved by: ………………………………………………………………………..………………….
(Rank, Approving Authority, date)
Please complete your completed application to:
INFORMED CONSENT WAIVER FOR TRANSPORTATION
Assumption of Risk for Military Helicopter Transportation
This is a voluntary release of liability and complete assumption of risk. I hereby release the 31st Marine Expeditionary Unit (hereinafter “31st MEU”), the United States Marine Corps, the Department of the Navy, the United States Government, and all agencies and instrumentalities thereof, its agents, officers, servants, and personnel (hereinafter “the government”), from any and all liability, claims, demands, and actions whatsoever resulting from the military helicopter transportation I receive from the United States Marine Corps.
This release applies to myself, and to my parents, spouse, children, guardian, executors, future heirs, assigns, creditors, and administrators. This release of reliability includes, but is not limited to claims based on negligence, both passive and active, of the government arising out of, or relating to any loss, damage, illness, death, or injury that may be sustained while a passenger in the military helicopter transportation from the Marine Corps.
I understand that in transporting me, the United States Government is not acting as a common carrier for hire and does not bear the liabilities attached to that status. I acknowledge that I voluntarily accept such transportation, and that I am under no compulsion to do so. I understand that flying in a military helicopter is known to me to be inherently dangerous and involves substantial risk of serious injury, including permanent disability, death, and severe physical consequences. I understand that in accepting such transportation from the government, I incur no obligation to the government except as imposed by this release.
I hereby authorize emergency medical treatment in the event of injury or illness. I also authorize trained health care providers, including but not limited to physicians, nurses, nurse practitioners, and hospital corpsmen, to administer routine and/or emergency medicines and treatments, as needed.
I further state that I, ______have carefully read the foregoing release, know the contents thereof, and sign this release as my own free act.
______
Date Signature of Releaser
Witness: ______
Witness: ______