World Bipolar Day 2017 Media Release Form
I acknowledge that I have read and agree to the following:

1. I hereby grant permission to International Bipolar Foundation (“IBPF”) and third parties identified by IBPF to use my video and/or photo and message on March 30, 2017 for the March 30th World Bipolar Day Campaign.

Photos and video content will be used on the International
Bipolar Foundation Website, Facebook, Twitter, e-newsletter and/or additional social media pages.

2. I will defend, indemnify and hold harmless IBPF, its directors, officers, employees, agents and representatives, successors and assigns against any and all claims, suits or other proceedings arising out of or in connection with the Identity, Materials or Recording, including, but not limited to, claims of copyright or other intellectual property infringement, defamation or misrepresentation.

Type your full name to acknowledge that you have read and agree to the above statement. *
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