Interview Release Form

GRANT

For consideration which I acknowledge, I consent to the recording of my statements and grant to Mount Holyoke College Club of Southern California (“Entity”) and Entity’s assigns, licensees, and successors the right to copy, reproduce, and use all of a portion of the statements (the “Interview”) for incorporation in the following work The Digest (the “Work”).

I permit the use of all or a portion of the Interview in the Work in all forms and media including advertising and related promotion throughout the world and in perpetuity. I grant the right to use my image and name in connection with all uses of the Interview. I understand that I have the right to inspect or approve use of my Interview as incorporated in the Work. The deadline to inspect or approve use of my Interview, prior to publication of the Work, will be provided by the Entity and will expire within a reasonable time, as determined by the editorial staff of the Work.

RELEASE

I release Entity and Entity’s assigns, licensees, and successors from any claims that may arise regarding the use of the Interview including any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity, or copyright. I acknowledge that I have no ownership rights in the Work. Entity is under no obligation to utilize the rights granted in this Agreement.

I have read and understood this Agreement and I am over the age of 18. This Agreement expresses the complete understanding of the parties.