Cupertino Rotary Media Release
Form for club members to indicate you have authorized media release. If you are under the age of 18, please contact the club for the correct form.
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Full name (first and last name) *
Actual Release

I hereby authorize the Rotary Club of Cupertino and its representatives (collectively “the Club”) in good faith (a) to capture my image and/or voice in a photograph, video, or other digital media (collectively “Media”) and (b) to use Media I make available to the Club and its representatives for educational and promotional purposes in any of its presentations and publications, including print, web-based, and electronic presentations and publications.

I hereby irrevocably authorize the Club in good faith to edit, alter, copy, exhibit, publish, and/or distribute Media that includes me or that I make available for any lawful purpose. In addition, I waive any right to inspect or approve any finished product produced from Media that includes me or that I make available to the Club. Additionally, I waive any right to payment, royalties, or other compensation of any kind arising from or related to the use of such Media. 

I hereby hold harmless, release, and forever discharge the Club from all claims, demands, and causes of action which I, my heirs, representatives, assigns, agents, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of the good faith use of Media that includes me or that I make available to the Club, or of this media authorization, waiver, and release.

By selecting I agree below I CONFIRM THAT I HAVE READ AND UNDERSTAND THE ABOVE MEDIA AUTHORIZATION, WAIVER, AND RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE. I HEREBY ACCEPT THE TERMS OF THIS MEDIA AUTHORIZATION, WAIVER, AND RELEASE. *
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Rotary Club of Cupertino Media Release Form March 2024
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