Consent Form and Publicity Release

I voluntarily and without compensation authorize photographs, interviews, written testimonials, audio recording, and/or videos to be made of me by, or on behalf of, Stop the Addiction Fatality Epidemic (SAFE) Project, (SAFE Project) and their partners. The photographs/videos/audio recording may be used for a variety of purposes including, but not necessarily limited to, SAFE Project website, social media channels, fundraising and educational print and digital collateral, advertising, and Public Service Announcements (PSAs).

I hereby grant to SAFE Project, their partners and all of the persons using the photographs/videos/audio recording with the consent of SAFE Project, the absolute right and permission to copyright, publish, edit, duplicate, and/or use the photographs/videos/audio recording in perpetuity and without any limitation or reservation, for any and all purposes of advertising, publications, training, or trade, whether for internal or commercial purposes in any media, specifically including the electronic media, throughout the world.

SAFE Project shall be the absolute owner of the photographs (and negatives)/videos/ audio recording. I authorize SAFE Project or their partners to publicize and/or display such photographs/videos/ audio recording, or to provide such photographs/videos/ audio recording to others of their choosing for display, without notice or payment of any royalty, fee, or other compensation of any character to me for the use of my likeness. I specifically waive any right of inspection or approval with respect to the use of the photographs/videos, or any copy used in connection therewith.

I hereby release and discharge SAFE Project, their partners and all other persons using the photographs/videos/ audio recording with the consent of SAFE Project, from any liability resulting from the use of such photographs/videos/ audio recording, and from any liability for what I might deem misrepresentation or defamation of me due to distortion, alteration, optical illusion, digital manipulation, or faulty reproduction that may occur in the development or use of any advertising, promotion, training, or publicity incorporating the photographs/videos/audio recording referred to herein and any written material which is part of or connected with same.