LEGAL NAME
PREFERRED NAME
DATE OF BIRTH
EMAIL ADDRESS
MOBILE PHONE NUMBER
PREFERRED DEPARTURE AIRPORT
KNOWN TRAVELER NUMBER
DIETARY RESTRICTIONS
EMERGENCY CONTACT NAME
EMERGENCY CONTACT PHONE NUMBER
ADDITIONAL COMMENTS OR INFORMATION
I, being of legal age, hereby give Sponsor, its licensees, successors, legal representatives, and assigns the absolute and irrevocable royalty-free right and permission to use my name and to use, reproduce, edit, exhibit, project, display, copyright, publish, post and/or resell photography images and/or moving pictures and/or videotaped images of me at or in connection with the Event, with or without my voice, or in which I may be included in whole or in part, photographed, taped, videotaped, and/or recorded from this date and hereafter, and to circulate the same in all forms and media for art, advertising, trade, social media, competition of every description and/or any other lawful purpose whatsoever. I also consent to the use of any printed matter in conjunction therewith. I hereby waive any right that I may have to inspect and/or approve the finished product or products or the editorial, advertising, or printed copy or soundtrack that may be used in connection therewith and any right that I may have to control the use to which said product, products, copy and/or soundtrack may be applied. I hereby release, discharge Sponsor, its licensees, successors, legal representatives and assigns 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 making, processing, duplication, projecting or displaying of said picture or images.
This Agreement is deemed to be made under and shall be construed under the laws of the State of Iowa, without regard to choice of law provisions. If any provision of this Agreement is determined to be invalid, such invalidity will not affect the validity of the remaining portions of this Agreement. This Agreement shall be binding upon the undersigned and upon its respective successors and assigns.
IN ACCEPTING AND SIGNING THIS AGREEMENT, Participant acknowledges and agrees that Participant has read and fully understands this Agreement, that participation in the Event is completely voluntary and not a condition of Participant’s employment, and that no written or oral agreements, understandings, representations, statements, or inducements apart from this Agreement have been made with or by Sponsor with respect to the subject matter hereof.
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6000 Westown Parkway, West Des Moines, IA 50266