.In consideration of my possible inclusion in the Montel Williams MS Foundation Newsletter or website (www.montelms.org), I
hereby grant The Montel Williams MS Foundation and it's directors, officers, employees, agents and all persons acting by,
through or in contact with them, permission to use my image, likeness (whether a photograph or drawing), in case in connection
with the foundation's newsletter publication, including print, electronic, on-line and other versions using any technology now
existing or hereafter developed, -in connection with the Montel Williams MS Foundation in any manner whatsoever, in all media,
in perpetuity worldwide. This grant is irrevocable.
I HEREBY RELEASE, HOLD HARMLESS AND INDEMNIFY -THE MONTEL WILLIAMS MS FOUNDATION FROM ANY AND
ALL LIABILITY FOR LOSS, CLAIMS, DAMAGES, AND/OR INJURIES THAT I OR OTHERS MAY INCUR ARISING OUT OF MY
PARTICIPATION AND/OR APPEARANCE IN THE NEWSLETTER OR WEBSITE OR FROM ANY OF IT'S PERMITTED USES.
I agree that this agreement shall be deemed made and performed in New York City, New York, whose laws shall govern and
whose courts shall have exclusive jurisdiction over any dispute relating to this agreement.
I HAVE READ THIS ENTIRE RELEASE AND FULLY UNDERSTAND ITS CONTENTS.
AGREED AND ACCEPTED:
Legal Signature:___________________________ Dated:___________________
Name (Printed):____________________________________________________
Address:_________________________________________________________
City:_________________________ State:_________________Zip:___________
Phone Number:____________________________________________________
DATE of event___________________________________
LOCATION of event____________________________________________
If under eighteen years of age: I approve the terms of this Personal Release and guarantee performance by my
child or ward
________________________________________
(Signature of Parent or Legal Guardian)
DATE of event___________________________________
LOCATION of event____________________________________________
hereby grant The Montel Williams MS Foundation and it's directors, officers, employees, agents and all persons acting by,
through or in contact with them, permission to use my image, likeness (whether a photograph or drawing), in case in connection
with the foundation's newsletter publication, including print, electronic, on-line and other versions using any technology now
existing or hereafter developed, -in connection with the Montel Williams MS Foundation in any manner whatsoever, in all media,
in perpetuity worldwide. This grant is irrevocable.
I HEREBY RELEASE, HOLD HARMLESS AND INDEMNIFY -THE MONTEL WILLIAMS MS FOUNDATION FROM ANY AND
ALL LIABILITY FOR LOSS, CLAIMS, DAMAGES, AND/OR INJURIES THAT I OR OTHERS MAY INCUR ARISING OUT OF MY
PARTICIPATION AND/OR APPEARANCE IN THE NEWSLETTER OR WEBSITE OR FROM ANY OF IT'S PERMITTED USES.
I agree that this agreement shall be deemed made and performed in New York City, New York, whose laws shall govern and
whose courts shall have exclusive jurisdiction over any dispute relating to this agreement.
I HAVE READ THIS ENTIRE RELEASE AND FULLY UNDERSTAND ITS CONTENTS.
AGREED AND ACCEPTED:
Legal Signature:___________________________ Dated:___________________
Name (Printed):____________________________________________________
Address:_________________________________________________________
City:_________________________ State:_________________Zip:___________
Phone Number:____________________________________________________
DATE of event___________________________________
LOCATION of event____________________________________________
If under eighteen years of age: I approve the terms of this Personal Release and guarantee performance by my
child or ward
________________________________________
(Signature of Parent or Legal Guardian)
DATE of event___________________________________
LOCATION of event____________________________________________
MONTEL WILLIAMS MS FOUNDATION WAIVER
Both waivers Must be signed and sent to Christi Medice 6394 Whittington Road Exmore, VA 23350
with a check for $35 adult/$10 children under 15 payable to :
The Montel Williams MS Foundation
Both waivers Must be signed and sent to Christi Medice 6394 Whittington Road Exmore, VA 23350
with a check for $35 adult/$10 children under 15 payable to :
The Montel Williams MS Foundation
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