PHOTO/VIDEO RELEASE

PHOTO/VIDEO RELEASE FORM

I hereby grant permission to the Anti-Defamation League, its officers, employees, directors,

licensees, assigns and affiliates (collectively, ADL) to:

•Photograph, film, audio or videotape, digitally image or otherwise record, reproduce or take any

likeness of me in any medium, individually or with others, or otherwise (“Images”),

•Record, reproduce or transcribe in any medium my voice, comments, remarks, responses and other

written or oral presentations or sound effects made by me (“Recordings”).

•Use, publish, exhibit, display, copyright, license, sublicense, transfer, edit, disseminate, or in any

other way use or exploit in any language, form or media, whether now or hereafter existing, without

prior approval, the Images and Recordings, and any parts or excerpts thereof, with or without my

name associated therewith, for any purpose, including but not limited to educational, commercial,

fundraising, trade and pictorial uses (“Publication”).

I release and agree to hold ADL harmless from any claims or liability for damages for libel, slander,

and invasion of privacy or other claims based on the Publication of any Images or Recordings.

Click to accept and agree to these terms.

First Name

Last Name

Mailing Street

Mailing City

Mailing State

Postal Code

Email address

Phone Number

Signature

Keying in your full name serves as your signature on this form. The parties agree that this agreement may be electronically signed and electronic signatures herein are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility

Date

MINORS: If the Images, Recordings or Publication are of a person who is under 18 years of age, a

parent or guardian must sign and fill out the form above and provide the name of the child here.

Child Name 1

Child Name 2