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Me and Dylan Down the Ups Look-Alike Contest Entry Form 26 and 27 October, 2009 Please print out, complete form and post to (with all fees) Me and Dylan Down the Ups ● 5 Cwmdonkin Drive
● Uplands ● Swansea ● SA2 0RA ● South Wales £1.00 Registration Fee
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Name _____________________________________________________________________________________________________________________ Address _____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________ Town ______________________________________________________________________________________________________________________ County _____________________________________________________________________________________________________________________ Postcode _____________________________________________________________________________________________________________________ Telephone (include area code) ___________________________________________________________________________________________ E-Mail Address ____________________________________________________________________________________________ Payment (please tick) { }I have completed
entry form and am enclosing a £1.00 cheque made payable to Dylan Down the
Ups for challenge entry fee
Dylan Down the Ups T-shirt
size not guaranteed) £5.00 Med
Large X
Large XXLarge
Cancellations: Challengers who have pre-registered and do not participate in the challenge, entry fee and t-shirt will not be returned Signature:_________________________________________________________________________________________________________________
Confirmation letters will be emailed, if email is provided. COMPLETED ENTRY FORM,
RELEASE FORM and CHEQUE
MUST BE POSTED TOGETHER |
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Me and Dylan Down the Ups
Look-Alike Challenge 26 and 27 October, 2009 Model Release/Talent Consent TESTIMONIAL RELEASE For good and valuable consideration, the receipt and
sufficiency of which are hereby acknowledged, I hereby agree as follows: 1. I hereby consent to and
authorize the use by Dylan Down the Ups, its respective licensees,
successors, assigns, and all persons acting with its permission (the
"Licensed Parties"), the right to use, publish and copyright my
name, voice, testimonial statement, picture and likeness in all media and
types of advertising and promotion for Dylan Down the Ups. 2. I agree that all
photographs of me used and taken by the Licensed Parties are owned by them
and that they may copyright the photographs. If I should receive any print,
negative or other copy thereof, I will not authorize its use by anyone else. 3. I agree that no
advertisement or other material need be submitted to me for any further
approval and the Licensed Parties will not be liable to me for any distortion
or illusionary effect resulting from the publication of my picture or
likeness. 4. I warrant and represent
that I have not previously authorized (which authority is still in effect),
nor will I authorize or permit, the use of my name, voice, testimonial
statement, picture, and likeness in connection with the advertising or
promotion of any business that is competitive to Dylan Down the Ups. 5. I further agree that the
Licensed Parties will have the right to attribute my testimonial statement
(or edited or paraphrased statements that have substantially the same
meaning) to me, which is an expression of my personal experience and belief 6. Nothing herein will
constitute any obligation on the Licensed Parties to make any use of any of
the rights set forth herein. 7. I understand that the
Licensed Parties will act in reliance on this consent and release, and
accordingly I hereby declare it to be irrevocable; and I hereby release and
discharge the Licensed Parties from any and all claims whatsoever in
connection with their lawful use of my name, voice, testimonial statement,
picture, and likeness described herein. Print Name ______________________________________
Signature
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