EDMONTON EPILEPSY ASSOCIATION MEDIA RELEASE FORM Please enable JavaScript in your browser to complete this form.I hereby agree to the following terms: *This field is marked as required and has to be checked to be submitted.REPRODUCTION RIGHTS I HEREBY GRANT THE EDMONTON EPILEPSY ASSOCIATION (EEA) including THEIR employees, agents, assigns, or other third party as the EEA may authorize on their behalf, the nonexclusive right to: (check all that apply). I CONSENT TO THE USE OF THESE RECORDINGS BY THE EEA for educational materials, publications and websites and other consistent purposes. I hereby assign and transfer to EEA all rights to these audio and visual recordings and all benefits and advantages to be derived there from. Editing, publication, distribution, broadcast and use of this material shall be at the sole discretion of the EEA, worldwide, in perpetuity. Intended uses: The Media Can Be Used in the Following:VideosPhotosEmail MarketingSocial MediaNewsletters/MagazinesWebsiteOtherCheck all that applyIf other, please specifySPECIFY EVENT *Write the date or title of event from which media content will be derived.Checkboxes - check all that applyI give permission for myselfI give permission for my childCheck all that apply. Select "permission for my child" if you are giving the EEA permission to use photos, videos and audios on behalf of your child.Child/Children's Name/s and age/sWrite the name of your child/children and their agesPrint Your Full Name *FirstLastEmail *EmailConfirm EmailSubmit
