Location Release Form

Video/Photo/Audio Consent Form

This Release and Consent relates to the real property (“Premises”), located at

______

and to any marks thereon, including without limitation any name, logo, trade name, trademark, slogan or artwork, (“Marks”).

  1. Company, whose name and address are set forth below, hereby grants to the University of Illinois at Urbana-Champaign with respect to use by the University of the Premises and the Marks in the video, photograph or audio recording described below as well as any video, photograph or audio recording reproduced either in whole or in part from the video, photograph, or audio recording described below regardless of whether these materials are used for fundraising, advertising, publicity, or any other purpose on behalf of either the University of Illinois or its Foundation (the “Program”) the following irrevocable rights:

a.To enter and remain at the time upon the Premises with personnel, equipment and sets for the sole and express purpose of recording and photographing scenes live or on recording, film or by any other process on the Premises.

  1. Without limiting the generality of paragraph 1 above, to photograph and record the Marks and the exterior and interior of buildings (“Buildings”) and other structures (“Structures”), including, but not limited to, signs and furniture contained in or on such Buildings and/or Structures which are on the Premises and to photograph and record any animals on the Premises.
  1. To use the Marks, the name of the Premises and/or the name of any Buildings or Structures located on the Premises in connection with UI’s use of the recordings and photographs made pursuant to this Consent and Release.
  1. To use throughout the universe and in perpetuity in, and in connection with, the Program and in any and all media, whether such media is now known or developed later, or as UI may desire, all recording and photographs, whether still or moving, made by UI pursuant to this Consent and Release. Company acknowledges that UI owns all rights in and to all such recordings and photographs. Without limit and generality of the proceeding sentences, UI may use such recordings and photographs in any program and in connection with advertising, publicity, marketing and exploitation thereof.

2. Company warrants, represents, and agrees that (a) Company has the sole right and authority to grant to UI all of the rights set forth herein and to enter into and sign this Consent and Release; and (b) it is not necessary for UI to obtain the consent of any other person or entity in order to exercise the rights granted to UI herein.

  1. UI shall not by virtue of this Consent and Release, obtain any right, title or interest in or to the Marks and/or the Premises, including the name, logo, trade name, trademark, slogan, or artwork of Company, except the right of use specifically set forth herein, and hereby acknowledges and agrees that all such use shall inure to the benefit of Company.
  1. UI is not obligated to actually use the Marks and/or the Premises, not obligated to produce the video, photograph or audio recording described below, and not obligated to include material photographed or recorded hereunder in the Program.
  1. Company agrees that Company has not paid any money or other valuable consideration to UI for the inclusion of the Marks and/or the Premises in the Program, nor has Company paid any money to anyone or accepted any money from anyone for the inclusion of any plug, reference, or product identification on the Marks and/or the Premises.
  1. In addition, Company waives all claims to compensation or damages based on the use of these images or sounds, or both, by either UI or the Foundation. Company also waives any right to inspect or approve the finished video, photograph or audio recording.
  1. Company understands that this release and consent is perpetual, that Company may not revoke it, and that it is binding on Company’s assigns.

Description of video, photograph, or audio recording:

An informational video for potential and accepted international students of the University of Illinois and their

families.______

______

Name of Company: ______

Address of Company: ______

Signature of duly authorized representative of Company: ______

Name of duly authorized representative of Company: ______

Date:______

Name and Address of photographer/videographer: ______

______

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2/2/2006 Form