HomeMy WebLinkAbout2026 Publicity Authorization and Liability Release - Gesa Credit Union
Publicity Authorization
and Liability Release Form
Gesa Credit Union ("Gesa") requests your permission to reproduce through print, audio, visual, or
electronic means activities in which you have participated. Your authorization will enable Gesa to make
use of recordings of Gesa activities in which you were involved through the use of mass media, displays,
brochures, websites, and other means of communication. This Form also contains a Liability Release.
• I fully authorize and irrevocably grant Gesa and its authorized representatives the right to print,
photograph, record, and edit or alter, as desired, my name, image, likeness, and/or voice on audio,
video, film, website, or any other electronic or printed formats currently developed or which may
be developed (referred to herein as “Recordings”). I waive any right to inspect or approve finished
products and materials.
• I understand and agree that the use of such Recordings will be without any compensation.
• I understand and agree that Gesa and/or its authorized representatives shall own exclusive right,
title, and interest, including copyright and/or any other property interest, in the Recordings.
• If I receive a prize or gift, I hereby accept the prize and/or gift and assume any risk of injury, harm,
loss and/or other damages associated with acceptance and/or use of this prize and/or gift.
• I understand that I am responsible for all taxes that may be required by law. If applicable, a 1099
form will be mailed if the prize is valued over $600. It is the winner’s responsibility to report this to
the IRS when filing taxes.
• I represent that I am 18 years of age or older and have the right to enter into this agreement, or if I
am under 18 years of age, my parent or legal guardian has consented to my execution of this
release by signing below. I represent that I have legal capacity to enter into this agreement. I
acknowledge and agree that this agreement is binding on my heirs, successors and assigns.
By signing below, I hereby release, forever discharge, and agree to defend, indemnify and hold
harmless Gesa and its authorized representatives from any and all actions, claims, damages,
costs, or expenses, including attorney's fees, which relate to or arise out of participation in a
Gesa event, acceptance of a prize or gift, and any use of the Recordings to which this
authorization pertains.
By signing below, I acknowledge I have read and understand the authorization and release and
agree to its provisions.
Participant Name: ____________________________________ Phone: __________________________
Address: ____________________________________________________________________________
City: ________________________________________________ State: ________ Zip: ______________
Signature: ___________________________________________ Date: __________________________
Name of Parent/Guardian: ______________________________ Relationship: ____________________
MK-455 12/22
Ryan Heffernan (360) 473-5777
1025 Burwell Street
Bremerton WA 98337
Docusign Envelope ID: 168F0FAA-A36F-8995-81E4-D0C33F10BA5E
8/10/2026