By signing my name below I understand I am entering into the following agreement with BurkeMedia Productions & the Ted Weill campaign.

I have been informed that BurkeMedia Productions is capturing footage and that my name, likeness, image, voice, appearance and/or performance are being recorded and made part of the recording in which I appear. 

  1. I grant BurkeMedia Productions and the Ted Weill campaign the right to use the video footage or photos in any format, now known or later developed. I grant, without limitation, the right to edit, mix or duplicate and use or re-use video footage or photos in whole or in parts as BurkeMedia Productions may elect. BurkeMedia Productions the Ted Weill campaign have complete ownership of the video footage and photos, including copyright interests. 
  2. I grant BurkeMedia Productions and the Ted Weill campaign the right to broadcast, exhibit, market and otherwise distribute the video footage and photos, in whole or in parts, and alone or with other products, for any purpose BurkeMedia Productions and the Ted Weill campaign determine. This grant includes the right to use video footage and photos for promoting or publicizing. 
  3. I have the right to enter into this agreement and am not restricted by commitments to third parties. 
  4. BurkeMedia Productions has no financial commitment or obligations to me as a result of the Agreement. 
  5. In consideration of all the above, I hereby acknowledge receipt of reasonable and fair consideration from BurkeMedia Productions. I have read, understand and agree to all of the above and that the rights granted BurkeMedia Productions herein are perpetual and worldwide: 
Name
Is this person over 18?
Parent/Guardian