Release *
By signing this release and checking the appropriate boxes below, I hereby grant URBAN BUSH WOMEN (the “Organization”) a non-revocable license to use my name and/or likeness captured in videos and electronic images as specified below for the projection design for Urban Bush Women and any other venues to which it may transfer (the “Piece”):
Signature *
I grant Organization this license to benefit Urban Bush Women and the production of the Piece, and with the express understanding that the licensed materials shall be used solely for the purpose of the projection design and promotional elements of the Piece. I do so with the express understanding that I will receive no monetary payment, royalty or any other additional consideration for the use of these materials. I irrevocably authorize Organization to edit, alter, copy, exhibit, publish or distribute these images for purposes of the Urban Bush Women production of the Piece, and I waive the right to inspect or approve the finished product of the projection design for the Piece, wherein likeness may appear. Provided the materials are used within the permitted scope of the license described herein, I hereby hold harmless and release and forever discharge Organization from all claims, demands, 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.
Individual photos and video of me (alone and containing no other identifiable persons) taken by the Organization

Sign the release and Press take video