Red Ribbon Week Contest Submission Form

In consideration of my engagement as a model, and for other good valuable consideration herein acknowledged as received, I hereby grant to the Council on Chemical Abuse, its legal representatives and assigns, those for whom the Council on Chemical Abuse is acting, and those acting with its authority and permission, the absolute right and permission to copyright, in its own name or otherwise, and use, re-use, publish and re-publish photographic portraits or pictures of me, or any video/audio segments in which I may be featured or included, in whole or in part, or composite or distorted in character or form, without restriction as to changes or alterations, in conjunction with my own or a fictitious name or reproductions thereof in color or otherwise, made through any medium at its studios or elsewhere, and any or all media now or hereafter known for illustration, promotion, art, advertising, trade or any other purpose whatsoever. I also consent to the use of any printed, published or recorded matter in conjunction therewith including the use of said pictures, video/audio segments on television, in magazines, newspapers, flyers and educational materials and on the internet or other social media platform , wherever, whenever, and in whatever manner they shall desire, consistent with good taste which will not be derogatory, degrading or detrimental to me in any way. I understand that I will not receive any compensation, now or in the future, for the above. I hereby waive any right that I may have to inspect or approve the finished product, advertising copy, printed matter or video/audio segment that may be used in connection therewith or the use to which it may be applied. I hereby release, discharge and agree to save harmless the Council on Chemical Abuse, its legal representatives and assigns, and all persons acting under its permission or authority for whom it is acting, from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of said pictures, videos or audio segments or in any subsequent processing thereof, as well as any publication thereof, including without limitation any claims for libel or invasion of privacy.