Photograph/Video General Authorization and Release Form

Undersigned hereby authorizes and grants permission to Society for Science (“Society”) and its employees, agents, designees, and/or sponsors, the absolute, irrevocable, and unrestricted right (1) to photograph, videotape, and/or otherwise record undersigned participating in the Event described above; (2) to display, publish, re-publish, broadcast, reproduce, edit, modify, adapt, distribute, sell, license, transmit, assign, prepare derivative works of, and otherwise use and re-use undersigned’s photograph, likeness or image in connection with the Event, in whole or in part, alone or in compilations, in all languages and in all formats and media (including print, broadcast, electronic, digital, online, and other media to be conceived or developed) and by any method, device, or process, and through any channels, now known or later conceived or developed, and for any business purpose without restriction, including for education, illustration, promotion, art, editorial, commercial, advertising and trade purposes; (3) to use undersigned’s name in connection therewith in the sole discretion of the Society; and (4) to copyright undersigned’s photograph, likeness or image in the name of the Society.

Undersigned hereby releases and discharges the Society and its employees, agents, designees, and/or sponsors, from any and all claims and demands arising out of or in connection with the use of undersigned’s photograph, likeness or image, including without limitation any and all claims for libel, invasion of privacy, violation of the right of publicity, or violation of copyright ownership. Undersigned hereby waives any right of inspection or approval of the use of undersigned’s photograph, likeness or image.

Undersigned acknowledges that undersigned is not receiving any compensation for the photograph, likeness or image, and undersigned releases all claims against the Society and its employees, agents, designees, and/or sponsors, for compensation related to the use of undersigned’s photograph, likeness or image.

Undersigned acknowledges that the terms of this General Authorization and Release have been completely read, are fully understood and voluntarily accepted. This General Authorization and Release shall be binding upon undersigned and the heirs, legal representatives, and assigns of undersigned. The laws of the District of Columbia shall govern the terms of this General Authorization and Release.