NeuroPace, Inc

Photography & Videography Release Form


By signing this Release, I,  grant permission to employees and agents of NeuroPace, Inc. to obtain and disseminate photographs and/or videos, including audio, in which I am featured.

I agree that NeuroPace owns all rights related to the photography and/or videography and that NeuroPace may sell, or assign or license the right to use the photographs and/or videos to third parties.

I understand that NeuroPace may use the photographs and/or videos for promotional, advertising, and other commercial purposes, as well as for publicity and other business purposes.

I agree that, without notifying me, NeuroPace may adapt the photographs and/or videos for use on multiple communications platforms, channels, and media including, without limitation, the internet and television, and in brochures and other print media.

I understand that NeuroPace may edit the photographs and/or videos post-recording, to eliminate or obscure content that is sensitive or not relevant to the needs of NeuroPace.

I waive any right to inspect, approve, or be compensated for the photography and/or videography.

I waive any claim for invasion of my personal privacy with respect to NeuroPace’s use of the photographs or video.

I release NeuroPace and its employees and agents from any claims, damages, or liability in connection with obtaining or using the photography and/or videography.

I understand that there is no time limit on the validity of this Release nor is there any geographic limitation on where the materials that are the subject of this Release may be distributed.

I am at least 18 years of age and competent to sign this Release. I have read this Release before signing; I understand its contents, meaning, and impact; and I freely accept its terms.

BY SIGNING BELOW, YOU AGREE TO THE TERMS AND CONDITIONS OF THIS AGREEMENT:

MAILING ADDRESS:

   

PHONE:

EMAIL:

Signed by NeuroPace Inc.
Signed On: September 22, 2016

NeuroPace, Inc http://www.neuropace.com
Signature Certificate
Document name: Photography & Videography Release Form
Unique Document ID: 186b212cdb4328a2aa0a8420ac6c3ad00219cb48
Timestamp Audit
2016-08-29 16:46:47 PDTPhotography & Videography Release Form Uploaded by NeuroPace Inc. - marketing@neuropace.com IP 173.228.54.97