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GNSI MURAL RELEASE FORM

____________________________________Artist's Name

Signature of this form grants consent of the adult individual named 
below (the artist) or, if artist is a minor, the legal guardian, to 
allow use of any images contributed to or produced during the Guild of 
Natural Science Illustrators (GNSI) event* listed below, for 
publication. In addition, the artist grants full ownership of the 
physical original work to the GNSI (to display, dissect, sell, archive 
or otherwise dispose of).The artist also gives consent for non-exclusive 
use, re-use, publishing and otherwise reproducing and displaying these 
images, individually or in conjunction with other images, writing, 
photos and video for promotion, art, advertising, and any other purpose 
whatsoever that relates to GNSI promotion, events, activities and grant 
reporting. The artist retains the rights to reproduce and use their 
image contributed to or produced during the event in anyway they see fit.

I hereby release and discharge GNSI from any and all claims and demands 
arising out of or in connection with the use of these images and the 
physical original, including and without limitations any and all claims 
for libel or invasion of privacy. This authorization and release shall 
also inure to the benefit of the successors, legal representative, and 
assigns of GNSI.

*The event: “*California Kelp Forest Chalk Murals*” was held and the 
images created at the University of California, Santa Cruz campus on 
Monday, July 4, 2016.

I have read the foregoing and fully understand the contents thereof. 
This release shall be binding upon me and my heirs, legal 
representatives and assigns.

____________________________________________________________________

Artist’s Printed NameDate

___________________________________

Signature

___________________________________Address__________________________________City, 
State, Zip

I, _____________________, being the parent or guardian of the above 
named minor, hereby consent to and join in the foregoing release and 
consent on behalf of said minor.

____________________________________________________________________

Printed NameDate

___________________________________

Signature

___________________________________Address__________________________________City, 
State, Zip

Please return this form to Taina Litwak, (co-coordinator GNSI California 
Kelp Forest Chalk Murals project)

Taina Litwakor [log in to unmask] 
<mailto:[log in to unmask]>

13209 Chestnut Oak Drive

Darnestown MD20878


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