Stop Everyday Killers

Too many loved ones are stolen from us because of everyday killers. Have you lost a loved one due to a preventable injury? Share his/her story with us.

 

Your story may be used to educate the public about everyday killers as part of a National Safety Council memorial. Your entry will become part of the memorial, which will go live in 2018.

 

Photo, Video and Story Release:

I hereby give irrevocable my consent and permission to the National Safety Council (“NSC”) and its nominees, agents, licensees, successors and assigns (collectively, the “Released Parties”), to reproduce, publish and otherwise use, with or without identification of me by name, my image or likeness, personal story, and/or voice in photo, print, video or audio recording or reproduction of same in whole or part, and/or any of my spoken or written words or comments submitted to National Safety Council (collectively, my “Resemblances”), in all forms and in all media now known or hereafter invented and in all manners, without any restriction as to changes or alterations (including but not limited to composite or distorted representations or derivative works made in any medium) for advertising, trade, promotion, publicity, exhibition, sales collateral, website, or any other lawful purposes without territorial, time, use, or other limitations, regardless of whether these materials are used for training, advertising, fundraising, publicity or any other purpose on behalf of the NSC.

I release and discharge NSC and the Released Parties from any liability by virtue of any blurring, distortion, alteration, optical illusion or use in composite form, or the comments made by me or the statements attributed to or about me or otherwise, whether intentional or otherwise, that may occur or be produced in the taking of photographs or videos, or in processing toward completion of a finished product or promotional material or other copy that may be used by NSC (collectively, the “Works”) for use by NSC.

I agree that NSC owns the copyright and all other intellectual property rights in any Works which incorporate my Resemblances. I waive any right or claim to any compensation for the use of my Resemblances, and also waive any right to additional inspection or approval of the Works.

I am of full age, have every right to contract in my own name, am competent to sign this release, and agree that this release shall be binding on me, my legal representatives, heirs, and assigns. I have read or my parent or legal guardian has read or have had read to me or my parent or legal guardian this release prior to its execution and am fully familiar with its contents.

 

 

Please Fill out the Form