I,
the undersigned, hereby consent to the unrestricted use by Drexel
University of my photograph, picture or portrait for use in magazines,
newspapers, trade journals, booklets, pamphlets, newsletters, advertisements,
the Drexel Web site, or other promotional materials. I hereby agree
to grant Drexel University worldwide rights in perpetuity for the
use of my image on the Drexel Web site.
I
further agree that the Web site and all of its elements, belong
entirely and exclusively to Drexel University, so that Drexel and
its licensees and assigns may duplicate, distribute, exhibit, or
otherwise use the materials, or any portion of them, without limitation
or restriction, throughout the world in perpetuity. I release Drexel
University and its licensees and assigns from any liability arising
from the use of my image and biographical information on the Drexel
Web site and authorize use of my image and biographical information
for Drexel marketing purposes including but not limited to multimedia
products, publicity, advertising and promotional uses, and supplementary
literary material.
I
intend to be legally bound by this release. This release is governed
by Pennsylvania State law. I represent that I am 18 years of age
or older.
Please
print your name, address and phone number clearly.
Name
Address
Phone (Day and Evening)
Signature
Signature of parent or guardian (if under 18 years of age)
Home