VeDA Live Event Guest Questionnaire

I understand that VeDA is producing a live or recorded video (“the Work”) for the purpose of educating the public about vestibular disorders. I have agreed to be interviewed on video and in writing and to provide information and other materials to be used in connection with the Work, including my personal experiences and opinions, medical information, financial information and experiences, remarks, and recollections as well as photographs, self-videos and documents that I may choose to provide (the “Interview Materials”). I understand that some or all of the Interview Materials may not end up being used in the Work.

GRANT OF RIGHTS
I hereby grant and assign to VeDA and their licensees, successors, and assigns the perpetual, worldwide, transferable (with the right to sub-license), royalty-free, fully-paid rights, including all moral rights, in connection with the Interview Materials for use as part of the Work and, any advertising, packaging or promotional materials for the Work, in any and all editions, versions, derivations and media:

– to quote or paraphrase all or any portion of the Interview Materials, and to generally use and publish or distribute the Interview Materials;
– to use my name, image, and biographical data and;
– to develop, produce, distribute, advertise, promote, or otherwise exploit the Work in any manner that VeDA or their assigns deems appropriate.
I understand and acknowledge that VeDA or their assigns will be the sole owner of all copyright, moral rights and other intellectual property rights in and to the Work and Interview Materials, but specifically excluding my personal, pre-existing materials that I share for the purpose of the Work. To the extent any Interview Materials are pre-existing, personal property, I hereby grant VeDA the perpetual, worldwide, transferable (with the right to sub-license), royalty-free, fully paid right to use and display, exploit, and create derivative works of such Materials, strictly as they relate to the Work. Other than those rights granted herein, I do not convey any other express or implied rights to the Interview Materials.

For good and valuable consideration, receipt, and sufficiency of which is hereby acknowledged, I, the undersigned, hereby grant permission to VeDA to photograph and to record my voice, performances, poses, acts, plays and appearances, and use my picture, photograph, silhouette and other reproductions of my physical likeness and sound as part of the Work and the unlimited distribution, advertising, promotion, exhibition and exploitation of the Work by any method or device now known or hereafter devised in which the same may be used, and/or incorporated and/or exhibited and/or exploited. I understand that I may not enjoin any exploitation of the Work as provided above.

RELEASE
In order to enable VeDA to develop the Work in any manner that VeDA may deem best, I hereby release and discharge VeDA and their licensees, successors, and assigns, from any and all claims, demands or causes of action, known or unknown to me now or in the future, that I may have against them by reason of anything contained in the Work or any of the above uses, including but not limited to any claims based on the right of privacy, the right of publicity, copyright, libel, defamation, or any other right.

CONSIDERATION
In consideration of the foregoing, VeDA has agreed to provide me with information about screenings and other relevant materials of the completed Work upon distribution. I acknowledge and agree that I am not entitled to receive any form of payment from VeDA and/or their licensees, successors, and assigns.

I am duly authorized to sign this Release.