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DrugGeneric.com Media Release Form

 
 
 
Date:
  _________________________
 
Description of entry(entries), i.e., written material, photograph(s), audio material, video material, etc., which is everything enclosed (“Media”). (You may also write on the Media itself.):
 

For consideration received including the opportunity to gain exposure, the receipt and adequacy of which are hereby acknowledged, I irrevocably grant to DrugGeneric.com, ("Company") and Company's assigns, affiliates, licensees and successors the right to use Media and each element contained therein (including, without limitation, all copyrights), in any form including composite or modified representations for all purposes including any commercial purpose such as advertising throughout the universe and in perpetuity. I waive the right to inspect or approve versions of Media used for publication or the written copy that may be used in connection with Media. I release Company and Company's assigns, affiliates, licensees and successors from any claims that may arise regarding the use of Media including any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity or copyright.

 

I represent and warrant that (1) I have read and understood this agreement, (2) I am over the age of 18, (3) I am the sole and exclusive owner of Media and have the full right and authority to enter into this agreement and to grant the rights herein, (4) I have correctly identified and provided true and accurate release forms signed by all individuals whose appearance, voice, etc., is incorporated in Media, (5) I have correctly identified and provided true and accurate release form(s) signed by all the legal owner(s)/contributor(s) (anyone who took any hand in creating Media, ghostwriter(s), photographer(s), videographer(s), recording engineer(s), etc.) which grant the Company the rights herein (6) I am not a member of any writing, theatrical, motion picture or television union or guild. I hereby agree to indemnify and defend Company against any and all losses, claims, debts, demands, liabilities, attorneys’ fee and all other damages or costs related to the above.   This Agreement expresses the complete understanding of the parties.

 

This Agreement expresses the complete understanding of the parties.

 

ALL MATERIALS ENTERED ARE NOT RETURNABLE and become the property of DrugGeneric.com.

 
Name:
  ___________________________________________
     
Address:
 

___________________________________________

___________________________________________

___________________________________________

 
Phone Number:
  ___________________________________________
     
E-Mail Address:
  ___________________________________________
     
     
Signature:  ___________________________________________
 
Parent/Guardian Consent [include if the named person above is under the age of 18]
 
I am the parent or guardian of the minor named above. I have the legal right to consent to and do consent to the terms and conditions of this material release.
 
Name:
  ___________________________________________
     
Address:
 

___________________________________________

___________________________________________

___________________________________________

     
Phone Number:
  ___________________________________________
     
E-Mail Address:
  ___________________________________________
 
Signature:  ___________________________________________
 
Witness
 
Witness Signature:  ___________________________________________
 

 

Non-Owner Contributor

 

I, the undersigned, represent and warrant that I am not the owner of Media, but am simply a contributor, ghostwriter, photographer, videographer, recording engineer, etc. I further warrant and agree that I neither seek nor claim ownership, nor will I seek or claim ownership of Media or any rights therein. I irrevocably grant to DrugGeneric.com ("Company") and Company's assigns, affiliates, licensees and successors the right to use Media, which can include the written word, an image, audio recording, video recording or all of the above in any form including composite or modified representations for all purposes including any commercial purpose including advertising throughout the universe and in perpetuity.

 
Name:
  ___________________________________________
     
Address:
 

___________________________________________

___________________________________________

___________________________________________

     
Phone Number:
  ___________________________________________
     
E-Mail Address:
  ___________________________________________
     
     
Signature:  ___________________________________________
 
Parent/Guardian Consent [include if the named person above is under the age of 18]
 
I am the parent or guardian of the minor contributor, ghostwriter, photographer, videographer, recording engineer, etc., named above. I have the legal right to consent to and do consent to the terms and conditions of this media release.
 
Name:
  ___________________________________________
     
Address:
 

___________________________________________

___________________________________________

___________________________________________

     
Phone Number:
  ___________________________________________
     
E-Mail Address:
  ___________________________________________
 
Signature:  ___________________________________________
 
Please send the completed form to:

DrugGeneric .com
14150 NE 20th St., Suite F1
Bellevue, WA 98007