Consent and Release



By signing below, I hereby give my permission and consent and grant Nicor Gas Company (“Nicor Gas”) and its affiliates and agents, without payment or royalty, the unlimited, perpetual, worldwide right to (i) take photographs and/or motion video of me and/or record my voice; (ii) produce, reproduce, print, publicize, advertise, publish, edit, display, copyright, transmit, use, and distribute, in print and/or electronically, including posting to the Internet and other forms of electronic media, the personal story I provide of my unique experience(s) with Pembroke Township (“My Story”); and (iii) use my name, video, voice, image, story, and other personal data I provide to Nicor Gas below (“Personal Information”) in connection with My Story, and in any advertising, publicity, in all forms of media including the internet, digital and/or printed media that may be distributed, displayed or transmitted in connection with My Story. I acknowledge, however, that Nicor Gas is not obligated to use My Story or any of my Personal Information.

I hereby waive (i) any right to inspect or approve the use of My Story and my Personal Information by Nicor Gas, and any advertising, publicity, or other print or electronic matter that may be used in connection with My Story and the Personal Information; and (ii) all moral rights including, but not limited to, the right of attribution.

I hereby assign to Nicor Gas any and all rights I may have, including copyright, in and to My Story. I acknowledge that the Nicor Gas shall own and retain all right, title, and interest in and to My Story, including copyright. 

I hereby release Nicor Gas, and its affiliates, officers, directors, employees, agents and all persons acting under its authority, from all claims and liability caused by or otherwise arising from Nicor Gas’ use of My Story and the Personal Information, and from any and all claims and liability of every kind relating to the production, reproduction, publication, editing, copyright, use, transmission, distribution, advertising, publicity, or display of My Story and the Personal Information for the purposes described herein.

I hereby represent that the following statements are true and accurate:

  • The picture, video and/or message submitted as My Story is of me and not any other individual
  • The picture, video submitted as My Story was taken within thirty (30) days of the date I agreed to this Consent and Release.
  • I am at least 18 years of age.
  • I agree that I will receive no compensation, consideration or royalty hereunder.
  • My Personal Information is true as of the date I sign this Consent and Release.