Skip survey header

Media Release Form

This question requires a valid email address.
5. Signature

By signing here, you agree to the following: I hereby grant permission to the New York City Department of Small Business Services (“DSBS”) on behalf of the City of New York (“City”) to use my name, likeness, attributed statement and/or photograph on its World Wide Web site or in other official City printed and/or sponsored publications without further consideration (“Programs”), and I acknowledge the City’s right to crop or treat the photograph at its discretion. I also acknowledge that the City may choose not to use my name, likeness, attributed statement and/or photo at this time, but may do so at its own discretion at a later date. I hereby waive the right to any claim against the City, including claims for fees or control of the aforementioned items now or in the future. I acknowledge that the materials referenced herein are owned by the City and that the City may copyright the same. I hereby waive any rights to inspect or approve such materials, Programs or the uses to which such materials and Programs may be applied. Nothing herein contained shall constitute any obligation of the City to make use of the materials and Programs. I acknowledge that the City retains all rights (but not the obligation) to use, inclusion, exhibition, distribution and other exploitation, in any manner or media whatsoever, whether now known or hereafter devised, throughout the world, in perpetuity, in and in connection with the Programs and any advertising, publicity or promotion of the services of the City. The City is the sole and exclusive owner, throughout the world in perpetuity, of all rights of whatever nature, including without limitation all copyrights, in all films, photographs and recordings made of or in connection with the Programs.

The undersigned (“Releasor”) hereby consents to the use, for advertising purposes, promotion, display and for general use, in all forms of media now known or hereafter devised, the name, likeness, voice and/or portrait of Releasor by the City (“Releasee”) in connection with Releasee’s governmental and promotional efforts including, but not limited to, the Releasee’s NYC Business Centers and Workforce1 Career Centers.

I also understand that once my image is posted on the DSBS website, the image can be downloaded by any computer user. Therefore, I agree to release from liability the entities listed below from any claims arising from the use or misuse of my image by third parties:
• City of New York, its officers and employees; and
• NYC Business Centers, and Workforce1 Career Centers, their service providers, officers and employees.

The City reserves the right to discontinue use of name, likeness, attributed statements, and/or photos without notice
*This question is required.
Clear
Signature of