Office of Public Affairs

Photo and Video Release Form

Photo, Video and Testimonial Release

"I give and authorize the University of Southern Maine, a campus of the University of Maine System, (“USM”) the right to use, display, copy, license or assign photographs and video footage of my image, voice, and words as recorded, photographed, taped and/or filmed during or in connection with activities or events created, hosted or otherwise developed by USM, for use in informational, promotional or commercial websites, publications and materials published by, or on behalf of, USM in photographic, print, video, electronic, digital or any other medium, including the Internet, (all of which are included in the term “Material”), and to do so with or without mention of my name, all in consideration of being included in the Material.

USM shall have the exclusive right to license and use the Material for promotional purposes of the University, including, but not limited to, the rights of copying, performance, public display, reproduction and distribution in all media, and the right to create, perform, display and distribute derivative works of the Material, for any purpose. This grant includes without limitation the right to edit, mix or duplicate and to use or reuse in whole or part.

I understand I have the right to revoke this authorization at any time. I understand that if I want to revoke this authorization I must do so in writing and present my written revocation to the USM Office of Marketing and Brand Management. I understand the revocation will not apply to any Material that has already been printed or published prior to USM’s receipt of my written revocation, but will apply only to future Materials.

I request that this Release and Authorization be construed and interpreted under the laws of the State of Maine, and if any part of it is determined to be invalid, I request the rest of it continue in full force and effect. I completely understand and have fully informed myself of the terms and conditions of this Release and Authorization by having read it, or having it read to me, before signing and I intend to be fully bound by it."

If you prefer to sign the Photo and Video Release by hand, please download the form, scan it and email it back to Alan Bennett, Social Media and Digital Content Specialist, alan.bennett@maine.edu.

 

Please enter your name. This will serve as your signature.
Please sign if photo/video subject is under age 18.