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Media Release Form


for good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, grant to: Mipham Shedra Tibetan Buddhist Meditation Center their subsidiaries, and their directors, officers, employees, agents, successors, assigns and all those acting with their authority or permission (collectively, “COMPANY”), permission to use, disclose, publish, distribute, publicly perform or display, create derivative works from, or otherwise reproduce in any manner my voice and image, including any video, photographic portraits, pictures, audio recording or images of me, or in which I may be included (collectively, the “Images”), in any and all media and anywhere in the world forever, without further payment or notice, in conjunction with, or as part of, COMPANY's activities, including fund raising and producing content on various platforms including but not limited to TV, Internet, DVD and VOD. I acknowledge that I receive a significant benefit from the COMPANY as a result of it allowing me to be a part of its TV programs and videos, and I confirm that my permission will continue, unaltered, should such opportunity cease.

In addition, I: (i) consent to the use of any narrative, text, symbol, audio, action, program, effect or other matter that may be used by COMPANY in connection with the Images, (ii) irrevocably waive any right that I may have to inspection or approval of any of the uses of the Images contemplated herein; (iii) waive any moral or similar rights I may have in respect of the Images, (iv) grant to COMPANY the irrevocable and unrestricted right to copyright in its own name, or otherwise, works consisting of, or incorporating, the Images, and (v) consent to any modification, alteration, distortion or blurring of, or optical illusion incorporating, the Images.

I understand that the Images may be broadcast and published via the internet, or otherwise released to the public, including media organizations or other third parties and I acknowledge that COMPANY shall not be held responsible for the conduct of such third parties in respect of such Images.

I hereby release and discharge COMPANY from any claim of liability by me, my heirs or my personal representatives, relating to the use of the Images in any of the manners described above, whether arising previously, now or in the future.

I acknowledge that I have read and understood the contents of this document and that COMPANY is relying on the permissions granted by me herein.

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