RELEASE FORM: I, ____________________________, have participated in a video project with the Sylvia Rivera Legal Resource Program of the Urban Justice Center, a tax-exempt, non-profit organization. I understand that my participation will be used in videos for educational purposes; video festivals; television exposure; in whole or in part for broadcasting services; for audiovisual, cassette, and closed circuit exhibition purposes; and all other non-broadcast purposes in any manner of media, in perpetuity throughout the universe. I understand that my participation offers no renumerations. I grant my permission for the Sylvia Rivera Legal Resource Program to use my name, likeness, voice, and biographical material about me in connection with program publicity, for instructional purposes, edit, produce, and record for duplication and distribution throughout the United States and abroad. I expressly release the Sylvia Rivera Legal Resource Program, it¹s licensees, and assignees from any privacy, decimation, or other claims I may have arising out of broadcast, exhibition, publication, or promotion of this program. ___________________________ _____________________________ Name (Please Print Clearly) Signature




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