This is the page where you will ask the user to fill out the following form to provide permission to use audio/video and demographic information as part of the project.

Dear project participant.  Please read below and then fill out the form.  Hit the SUBMIT button when completed.  If you have any questions, please contact me first, thanks!

I grant permission to Laura Milkins, to tape, video and/or photograph me and record my voice and conversation including quotes, paraphrases, sounds, and performance or participation in the Great America Project. I also understand and agree that I release the rights in connection with such tapes, videos, podcasts, photographs and recordings. For purposes of clarity, I expressly waive any and all moral rights I may have in connection with my appearance. I agree that Laura Milkins shall be the exclusive owner of all copyright and other rights in and to such taping, videos, photography and recording and will be able to use them forever and throughout the universe, and to license herself to use them, in any manner and in any and all media now known or hereafter discovered or developed along with any incidental uses in connection with the merchandising and promotion of Laura Milkins, the performance artist, and her related creative endeavors.

I further agree that Laura Milkins may license others to use the tapes, videos, podcasts,
photographs and recordings or any excerpts thereof, including my name, image, voice, likeness and any related or derivative versions of this content (including translation, foreign rights, serialization, syndication, photocopying, abridgement, adaptation, reprint, dramatization, and electronic recording and reproduction of any sort) in all media throughout the universe for any purpose.

I hereby agree to release, defend, and hold harmless, Laura Milkins, including any firm publishing and/or distributing the finished product in whole or in part, whether on paper or via electronic media, from and against any claims, damages or liability arising from or related to the use of the photographs, including but not limited to libel, false light, invasion of privacy, rights of publicity, any misuse, distortion, blurring, alteration, optical illusion or use in composite form, either intentionally or otherwise, that may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution.

I am at least 18 years of age  or older and I am competent to contract in my own name. I have read this release documentation before submitting below, and I fully understand the contents, meaning and impact of this form.