•   I hereby grant to The Regents of the University of California permission to reproduce my name, likeness, identity, voice, photographic image, videographic image and oral or recorded statements and/ or permission to display original works, including, but not limited to visual art, film/video and live performance in any publication of The Regents of the University of California intended for research, educational, promotional, fund-raising or other related use, including but not limited to, film broadcast, printed publications, web pages and web-based publications, associated with UCLA and understand that the University shall have the absolute right to display, distribute, and/or publish them in any manner, for any purpose, and in any form including, but not limited to, print, electronic, video, and/or Internet.

•   By checking this box, I waive and release The Regents of the University of California and its officers, agents and employees, from any claim or liability relating to the use of my original works, including, but not limited to visual art, film/video and live performance or my name, likeness, identity, voice, photographic image, videographic image, oral or recorded statements.

•   I acknowledge that The Regents of the University of California will rely on this permission and release in producing, broadcasting, and distributing materials containing my original works, including, but not limited to visual art, film/video and live performance, my name, likeness, identity, voice, photographic image, videographic image or oral or recorded statements, and that I will receive no money or remuneration of any kind from The Regents of the University of California related to this permission and release or the materials covered by this permission and release.

•   I am an adult, 18 years or older, and I have read and understand this agreement and I freely and knowingly give my consent to The Regents of the University of California as described herein.