SPECIFIC EVENT AUTHORIZATION AND RELEASE
I, ______________________________, hereby grant to the Pacific Northwest Alliance
Institutions (PNW-COSMOS: University of Montana, Montana Tech, Montana State University,
Washington State University, Heritage University, University of Idaho, Salish Kootenai College,
and Northwest Indian College)(“Grantees”) the non-exclusive and irrevocable rights and license
to make, edit, and use, digital and non-digital images (including negatives, duplicates and
prints) and/or sound recordings of me for educational purposes, for non-commercial publicity,
news, and advertising about the PNW-COSMOS, or for contemporaneous or later broadcast in
any media. These images and recordings include, but are not limited to print, video, audio,
worldwide web, alteration of photo or voice recording, performance, and broadcast, including
podcast and internet streaming video (collectively “images and/or sound recordings”). All such
use shall be for the purpose of promoting, supporting, or otherwise furthering the missions of
the Grantees.
This license covers all images and/or sound recordings made on October 25th and 26th, 2015, in
connection with the Summit event described as NSF AGEP-T PNW-COSMOS Year 2 Summit.
I relinquish and give to the Grantees and their successors and assigns, if any, all rights, title, and
interest I may have in any aforementioned images and/or sound recordings. I release the
Grantees from any and all claims of payment for performance rights or residuals, or from any
legal claim based on the use of said aforementioned images and/or sound recordings.
FERPA Information Release: The Family Educational Rights and Privacy Act (FERPA) is a Federal
law that protects the privacy of students’ educational records. The law establishes certain rights
for students regarding the privacy of their educational record. In accordance with FERPA, it is
the University of Montana, Montana Tech, Montana State University, Washington State
University, Heritage University, University of Idaho, Salish Kootenai College, and Northwest
Indian College’s policy to withhold certain educational records unless the student provides
consent to disclose information. By signing this release, you agree to release information about
your attendance in University of Montana, Montana Tech, Montana State University,
Washington State University, Heritage University, University of Idaho, Salish Kootenai College,
and Northwest Indian College courses.
I have read and understood this Authorization and Release and do hereby agree to its terms
and conditions. In addition I acknowledge that by executing this release I have the authority to
grant all rights contained herein.
DATE:________________________________________
Signature: ____________________________________
Printed Name: _____________________________________
Address: __________________________________________
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