Shivananda New Light Collective Inc.

MEDIA, FILM AND AUDIO CONSENT FORM

Ā 

FOUNDATION: SHIVANANDA NEW LIGHT COLLECTIVE INC is a nonprofit corporation. The corporation

is organized exclusively for charitable, educational, religious or scientific purposes within the meaning

of section 501(c)(3) of the Internal Revenue Code. EIN NUMBER: 92-1417624

1155 Camino Del Mar #413, Del Mar, CA 92014-2605

www.shivananda.org

Ā 

I,Ā undersigned with the form hereby give my consent to the Shivananda New Light Collective Inc.:

I,Ā undersigned with the form hereby DO NOT give my consent to the Shivananda New Light

Collective Inc.:

  1. To record my likeness, and or voice on a video, audio, photographic, digital, electronic or any other medium in connection with today's events of recordings without any expectation of compensation now or in perpetuity.
  2. To agree to allow the Shivananda New Light Collective Inc., and their assigns, to record, distribute, and disseminate the aforementioned material in any manner, including but not limited to social media (Facebook, Instagram, etc).
  3. To allow the Shivananda New Light Collective Inc to retain all rights to the produced media for potential future use in speeches, books, films and in all other public or private distribution in perpetuity.
  4. To hereby indemnify the Shivananda New Light Collective Inc from any and all claims, demands actions, causes of actions, suits, cost, expenses liabilities, and damages whatsoever that I may hereafter incur from liability for any violations of any personal or proprietary right I may have in connection with such media productions, likeness, voice, name or image in association with this material and productions.
  5. I further understand that no part of this film, production, or recording created between myself, my house and property and the Shivananda New Light Collective Inc, may be duplicated in any expression on any platform unless authorized by the Shivananda New Light Collective Inc in writing. I understand that no part of content may be used by me for disclosure or distribution of any kind, and if found in violation of this agreement I agree to pay all legal fees for both parties herein to resolve any conflict that may arise as a result.

I have read and fully comply as well as understand the terms of this agreement.

Submitted form is valid as a signature.

Contact Us

If you have any questions, concerns or complaints about this Media, film and audio consent form, please contact us by email:Ā [email protected]