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Sil-Gps Ip Ic Release Form 4may18

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poquizcabinta
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© © All Rights Reserved
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19 views2 pages

Sil-Gps Ip Ic Release Form 4may18

Uploaded by

poquizcabinta
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Intellectual Property and Informed Consent

RELEASE FORM
For use with PHOTO / NAME / VIDEO / AUDIO / GRAPHICS / MAP / QUOTATION

Can be filled out by the author, but to be signed further below by the one granting
release or permission to SIL International:

I, _________________________________________, hereby grant to SIL International (SIL), voluntarily


and without compensation or restriction of any kind, full use of the map, audio recording, or photographic
or video image(s) of or by me, or of anyone for whom I have legal responsibility (named below); or use of
my name in this publication; or the quotation(s) listed below (or cited on an added page), of which I am
the originator or creator, for any official publication, presentation, exhibit, video, web or other print or
digital format, or for any other form of publication or distribution now known or hereafter invented. I further
grant to SIL International full rights to republish, without time restriction, these recordings, graphics,
quotations, or images in official SIL International publications and reports.

Describe the item you give permission to use, below (add lines, as needed):

Photo(s), title/description (and approximate date) of each: _________________________________

Graphic(s), title/description of each: ___________________________________________________

Map(s), title/description of each: ______________________________________________________

My name, or Quotation(s) by me - title/description of each: _________________________________

Video(s), title/description of each: _____________________________________________________

Audio(s), title/description of each: _____________________________________________________

Your signature (can be typed in electronically), and address (for contact purposes):
Printed name: ________________________________ Signature: _______________________________

Address: ____________________________________________________________________________

City: ____________________________ State: __________ Country: ____________________________

Date signed: ____________________________ 20____

How you want the attribution (acknowledgment) to be worded:


”Used with permission”

”Photo by _____________________”

”Copyright (your name) __________”

Other: “_______________________”
If the recognizable person in an image (or named/quoted) is a minor, or recognizes you
as his or her signatory representative, please complete this section giving your Informed
Consent Release to use that other person’s image or name (as described above):

Print the name of the minor or individual whom your signature represents: _________________________

Print your name—and give your relationship to the minor or person represented: ___________________
____________________________________________________________________________________

Sign your name, granting permission on behalf of the minor or other person: _______________________

Address: ____________________________________________________________________________

City: ____________________________ State: __________ Country: ____________________________

Date signed: ______________________ 20____

Person who requests this form for SIL International (typically the author):

SIL Representative: ___________________________________________________________________

For the SIL publication, to be entitled: _____________________________________________________

SIL International gathers images throughout the world in an effort to tell the story of language-based
development for ethnolinguistic minority peoples. SIL appreciates your cooperation and consent in
allowing us to use your photo image, graphic, map, video, audio recording, or textual citation in various
media. You have our assurance that these images, audio, or quotations will be used only for official
purposes and with the respect and consideration to which you are entitled.

SIL International
Global Publishing Services
7500 W. Camp Wisdom Road
Dallas, Texas 75236-5629

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