MIT SWE WiSE Speech Contest 2010 ------------------------------------------------------------- Publicity Release Form
Dear Parents and Guardians,
Your student will be coming to MIT to participate in the 2010 MIT SWE WiSE Speech Contest.
Photographs of the contestants and the winners of the speech contest will be taken at the event; in
order for your student to be included in the published photographs, this release form must be signed.
Please make sure that this form is submitted along with the contest registration form, so that your
student may be included in the broadcast.
Thank you,
Kimberly Li & Sumi Sinha
MIT SWE | WiSE Coordinators
Publicity Release
Massachusetts Institute of Technology
ASSIGNMENT, CONSENT, and RELEASE
This release is executed for _________________________________ (name of student) by
_________________________________ (name of parent/guardian) to Massachusetts Institute of
Technology (“MIT”).
I, the undersigned, on behalf of _________________________________ (name of student) and
for those who would claim under, through, or for her hereby:
a) Assign all right, title, and interest we may have in the photographs and/or films and/or
likenesses of _________________________________ (name of student) produced,
distributed or displayed, or otherwise transmitted by MIT or television, newspaper, radio
outlets, or any other media (Collectively, the “Press”) during the period of the MIT Society
of Women Engineers (the “SWE”) Speech Contest.
b) Consent that MIT or the Press, newspaper, or radio outlets may publish, or use said
photographs and/or film and/or likenesses for itself, in a manner consistent with MIT
policies and procedures.
c) Release MIT and its employees, volunteers, and agents, from all claims or demands I or my
child may have in connection with said photographs and/or films and/or likenesses.
I hereby waive any right that I may have to inspect and/or approve the finished product or press
release that may be used in connection with the photographs, films, or likenesses.
I represent and covenant that I have read and fully understand the above paragraphs and knowingly
and voluntarily execute this ASSIGNMENT, CONSENT, and RELEASE.
___________________________________
(Signature of Parent/Guardian)
___________________
(Date)
MIT Society of Women Engineers • 84 Massachusetts Avenue, Room 447 • Cambridge, MA 02139 • 617-253-2096 •
http://web.mit.edu/swe/www/wise