I hereby grant Quarter Midgets of America
("QMA") permission to use my photograph(s) (the “Photograph”)
and/or caption(s) (the “Caption”) (collectively, the “Submission”)
as part of the QMA’s website (the “Website”) and in any of its
publications, without payment or any other consideration.
I understand and agree that these materials
will become the property of QMA and will not be returned. I
also understand that my Submission may or may not be displayed
on the Website, at the sole discretion of the Website Administrators.
I understand that this consent is voluntary
and may be revoked at any time. You have the right to revoke
your consent to future use of your Submission at any time by
contacting us at the address below. Please be sure to provide
us with a way of identifying the Photograph/Caption concerned.
Your name and this form will be kept and used to identify your
Submission for removal should you wish to revoke your consent
and to identify you publicly on the Website as the photographer
should your Photograph be selected to be displayed on the Website.
I hereby represent and warrant that the Photograph
does not contain any identifiable individuals and that no individuals
other than myself or the minors to which I am legal guardian
are referred to in the Caption.
I hereby irrevocably authorize QMA to edit,
alter, copy, exhibit, publish or distribute this Submission
for the purposes of publicizing Quarter Midgets of America’s
programs or for any other lawful purpose. In addition, I waive
the right to inspect or approve the finished product, including
written or electronic copy. Additionally, I waive any right
to royalties or other compensation arising or related to the
use of the Submission.
I hereby represent and warrant that I am the
photographer of the Photograph and the author of the Caption,
that I have all rights, including all intellectual property
rights, to my Submission and that no rights of third parties
have or will be infringed by the use of my Submission to QMA
and/or the displaying of my Submission on the Website.
I acknowledge that QMA has no control over,
and is not responsible for, any use or misuse including, but
not limited to, any alteration, modification, reuse or distortion
of my Submission that may occur or be caused by third parties.
QMA will not be monitoring and has no control over third parties’
use or misuse of my Submission displayed on the Website.
I hereby hold harmless, release and forever
discharge QMA from all claims, demands, and causes of action
which I, my heirs, representatives, executors, administrators,
or any other persons acting on my behalf or on behalf of my
estate have or may have by reason of this authorization.
I am at least 21 years of age and competent
to contract in my own name. I have read this release before
signing below and I fully understand the contents, meaning,
and impact of this release.
I also certify that the electronic signature
entered below is that of the person so named and that it represents
voluntary consent to be bound to the terms of this document.
An electronic signature is a legal
concept for using an electronic symbol to represent a person's
volitional consent to be bound to the terms of a document.
Please use your QMA Member
number below to identify
your photo. If your member number is 1234567 then name the photo 1234567.jpg
(or .gif as appropriate.)
E-mail all photos to