7511 Greenwood Ave. N. #815
Seattle, WA 98103
I recognize the value of preserving my personal and family history. By sharing my Likeness, with RBGM, I am preserving my personal and familial legacy, while at the same time contributing to the historical preservation and collection of African American history.
I irrevocably authorize Intergenerational Solutions and/or its agents to edit, alter, copy, exhibit, publish, distribute or not use my story for purposes of publicizing the RBGM archive or for any other lawful purpose. Intergenerational Solutions will only grant written consent to projects and publications requesting to use RBGM website content that reflect the mission of the RBGM digital archive.
I understand and agree that I have submitted these materials to RBGM voluntarily and they will become the property of Intergenerational Solutions and RBGM and will not be returned. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my information appears. I understand that the recordist/videographer/photographer can see no risk presently, and that I take full responsibility for my involvement in this project and the risks that it may entail. All of the above rights are granted without any restriction or reservation of any kind or nature whatsoever and without any right on any part to enjoin or interfere with the production, distribution or exploitation of RBGM.
Additionally, I understand that I will not receive any royalties or other compensation arising from or related to the use of the information. I hold harmless Intergenerational Solutions from any claims, demand, 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 or the use of my story, likeness, and photos. I certify by my signature that I am 18 year of age and am competent to contract in my own name. If I am under 18 years of age my parents have read this document and have given their consent by signing below. By signing this, I hereby release RBGM from any and all claims and demands arising out of or in connection with such use, including, without limitation, any and all claims for invasion of privacy, infringement of my right of publicity, defamation (including libel and slander), false light and any other personal and/or property rights.