media accreditation form

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MEDIA ACCREDITATION PROFORMA
TALISMAN SABER 2015
Media Accreditation
This form acknowledges the accreditation of the media organisation and correspondent
whose name/s appear below as a Defence correspondent in the region.
ACCREDITATION OF CORRESPONDENT/S
(Name/s)…………………………………………………………………………………
(Print)
Contact number/s:
……………………………………………………………………………….………….
Name of News
organisation…………………………………………………………………………….
(Print)
Authorised by (Name of News Director/Chief of Staff)
…………………………………………………………………………………………….
(Print name, add signature and date)
Contact
Details……………………………………………………………………………………
Approved by:
………………………………………………………………………..………………….
(Rank, Approving Authority, date)
Please email a scanned copy of your completed application to:
[email protected]
INFORMED CONSENT WAIVER FOR TRANSPORTATION
Assumption of Risk for Military Helicopter Transportation
This is a voluntary release of liability and complete assumption of risk. I hereby
release the 31st Marine Expeditionary Unit (hereinafter “31st MEU”), the United States
Marine Corps, the Department of the Navy, the United States Government, and all agencies
and instrumentalities thereof, its agents, officers, servants, and personnel (hereinafter “the
government”), from any and all liability, claims, demands, and actions whatsoever resulting
from the military helicopter transportation I receive from the United States Marine Corps.
This release applies to myself, and to my parents, spouse, children, guardian,
executors, future heirs, assigns, creditors, and administrators. This release of reliability
includes, but is not limited to claims based on negligence, both passive and active, of the
government arising out of, or relating to any loss, damage, illness, death, or injury that may
be sustained while a passenger in the military helicopter transportation from the Marine
Corps.
I understand that in transporting me, the United States Government is not acting as a
common carrier for hire and does not bear the liabilities attached to that status. I acknowledge
that I voluntarily accept such transportation, and that I am under no compulsion to do so. I
understand that flying in a military helicopter is known to me to be inherently dangerous and
involves substantial risk of serious injury, including permanent disability, death, and severe
physical consequences. I understand that in accepting such transportation from the
government, I incur no obligation to the government except as imposed by this release.
I hereby authorize emergency medical treatment in the event of injury or illness. I also
authorize trained health care providers, including but not limited to physicians, nurses, nurse
practitioners, and hospital corpsmen, to administer routine and/or emergency medicines and
treatments, as needed.
I further state that I, __________________________ have carefully read the
foregoing release, know the contents thereof, and sign this release as my own free act.
_____________
Date
_________________________________________
Signature of Releaser
Witness: ___________________________________
Witness: ___________________________________
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