Media Release & Consent Form

I consent to the unrestricted use, by the International Association for Impact Assessment (IAIA) and those acting with its permission and authority, of any and all media taken or submitted, in whole or in part, unlimited use, for all purposes in any form or medium, including, without limitation, its use through or on any electronic media, including the Internet.

I hereby authorize the IAIA to edit, alter, copy, exhibit, distribute and publish in print, video, audio recorded productions, and on the World Wide Web this material for purposes of publicizing IAIA programs or other lawful purpose without payment or any other consideration.

By giving permission to record, I understand that:

• The materials will be used only for nonprofit/educational purposes.
• The above-named IAIA will not release the materials to any other nonprofit or commercial entity without seeking my permission.
• Any proceeds from the sale of published or printed matter containing the materials will be used to support the mission of IAIA.
• The materials will become the property of IAIA, stored in a place chosen by IAIA and will not be returned to me.

In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. I waive any right to royalties or other compensation arising or related to the use of the materials. I hereby hold harmless and release and forever discharge the IAIA from all claims, demands, liability and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.