Upon signing the associated document, I hereby grant permission to Ampliphi Inc., its employees, representatives, and agents to record and use my image, voice, and likeness in video recordings (hereinafter referred to as the “Video”) for the following purposes:

The Video will be used in the Plastic Waste Free July Campaign throughout website placement, promotional materials, and campaign social media dissemination.

I understand and agree to the following terms:

Consent: I willingly consent to being recorded in the Video and understand that my image, voice, and likeness may be used, reproduced, edited, published, or distributed in any medium or format, including but not limited to print, online, television, and social media platforms.

Release: I hereby release Ampliphi Inc., its employees, representatives, and agents from any and all claims, demands, causes of action, suits, liabilities, and expenses arising out of or in connection with the use of the Video, including without limitation any claims for defamation, invasion of privacy, copyright infringement, or any other intellectual property rights.

Truthfulness: I affirm that all statements made by me in the Video are true and accurate to the best of my knowledge. I understand that providing false or misleading information may have legal consequences and could result in the termination of any agreements or relationships with Ampliphi Inc.

Compensation: I acknowledge that I am providing my participation in the Video without any expectation of compensation, financial or otherwise, except as otherwise agreed upon in a separate written agreement.

Governing Law and Jurisdiction: This Video Release Form shall be governed by and construed in accordance with the laws of the Georgia Arbitration Code “GAC”. Any disputes arising under or in connection with this Agreement shall be subject to the exclusive jurisdiction of the courts located in Georgia, United States.