The Wilderness Society

For good and valuable consideration, including the opportunity extended to me by The Wilderness Society to appear and/or share statements and stories, I, being of lawful age, do hereby acknowledge and agree as follows:

I grant to The Wilderness Society (“TWS”), its licensees, assigns and transferees (the “Licensed Parties”), the non-exclusive right to copy my image, my likeness, my voice, my name, the text messages and statements I have made and provided to TWS, and all aspects of the stories I tell to TWS through social media communications, email, text messages or otherwise, for use in any form of media, including social media activities, email, blogs, websites, brochures and other communications, including through tagging on social media platforms, in support of the protection of public lands, including use in fundraising materials for The Wilderness Society’s work. The Undersigned hereby grants to The Wilderness Society the unqualified and perpetual right to use, and consents to the perpetual use of my image, name, likeness, voice, text messages, statements and stories in any and all media throughout the world, including, by way of illustration, but not limitation, the display, broadcast or rebroadcast of films, videotapes, or still photographs, social media, email, blogs, websites, brochures and other communications, including through tagging on social media platforms. I have the right and the authority to grant to TWS the rights granted herein and represent that the messages, statements and stories provided to TWS are my original work. I also understand that the Licensed Parties have no obligation to use my image, my likeness, my voice, my name, the text messages and statements I have made and provided to TWS, and all aspects of the stories I tell to TWS, or any of the rights set forth herein.  

The Undersigned hereby releases and forever discharges The Wilderness Society, its licensees, assigns and transferees, from and against any and all claims, demands, liabilities, causes of action, or damages arising out of the above mentioned uses of the image, voice, stories, name, text messages, statements and likeness of the Undersigned. 

If parent or legal guardian signs below, in addition to the terms above in this Release Form, said parent or legal guardian also agrees to RELEASE, HOLD HARMLESS and INDEMNIFY The Wilderness Society, any other sponsors/providers, and their employees, agents and contractors for any claims of the minor and any claims by any third party arising out of this Release Form.

I hereby understand that because I am granting the Licensed Parties the use of my name, image and likeness, text messages, stories and voice in any and all media throughout the world, I may be sought out by media news sources in connection with my expressed support of public lands. Therefore, I hereby additionally consent to the disclosure of my name and contact information by TWS to such news media inquiries provided that TWS informs me in advance that it will be providing my contact information above to such a request.  I understand that I may choose to decline to be interviewed in any format if contacted by a news media source and further understand that it will be my responsibility to inform the new media source that I decline to be interviewed by them.