2022 Fellowship Release Form

Release Form

The Michigan Economic Justice Fellowship program will be making audio, video or photographic recordings of the participants and will be receiving written materials from participants, including personal statements, strategies, speeches, and other materials.

By signing below, I hereby give my consent for EJAM to use my likeness, picture, image, voice, and any of my non-confidential written and other materials, without notifying me in advance in connection with EJAM Program(s), including reproduction, use and transmission for marketing purposes. I hereby give EJAM permission to make, use, edit, transmit and distribute copies of my non-confidential materials for educational, promotional, advertising, and trade purposes, through any medium or format, including, but not limited to, videotape, audiotape, film, photograph, television, radio, digital, internet, or exhibition.

I wave any right to inspect or approve the finished images or any printed or electronic material that may be used with them, or to be compensated for them. I further acknowledge that all materials and reproductions shall remain the sole property of EJAM, and that EJAM may use them for the purposes listed in the paragraph above without payment of any consideration to me or my estate or representatives.

I hereby release EJAM from any and all claims arising from my acts or statements on the broadcast, video, photographs or materials or any use of the foregoing by EJAM. I hereby release EJAM and those acting pursuant to its authority from liability and any violation of any personal or proprietary right I may have in connection with such recording or use.

This consent is given freely and voluntarily and will be in effect from this date forward unless and until I revoke this consent in writing.