Audio/Video Images Release Form
Prevention Research Center
The Pennsylvania State University
PERMISSION TO USE SEMINAR AUDIO/VIDEO RECORDINGS
ON THE PREVENTION RESEARCH CENTER WEBSITE
I,
, do hereby consent to allow the Prevention Research
Center (PRC), Penn State College of Health and Human Development, to upload and use video
and/or audio tapes with my image and/or voice on its web site.
In giving this consent I release the Prevention Research Center, the College, and those acting
directly on their behalf from all claims, demands, actions, complaints, suits, or other forms of
liability that shall arise out of or by reason of the use of my likeness or voice on the Internet
or in any other electronic/digital medium.
If I have provided a seminar on ongoing research that is being/has been externally funded, I
acknowledge that I have the right to publicly share findings according to my signed and
executed agreement/contract with the funder.
It is further understood and I agree that no monies or other consideration in any form will
become due to me at any time because of the above-described use of my likeness or voice.
Signature
Date:
Printed Name:
Title:
Address:
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