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Calendar Cops™ Participant Application Form
Fields marked with () are required
First Name:   
Last Name:   
Rank:   
Department:   
Special Unit:
(if any) 
 
Permission Of
Chief/Director:
    YES        NO
Height:  
Weight:  
Head Shot
Photo:
  
Full Body
Photo (shirtless):
  
Optional Photo:  

Address:   
City / Town:   
Zip:   
Telephone:  
E-mail:   

*** Release Terms ***
I hereby irrevocably grant to North Jersey Media Group, its past, present, and future affiliates, subsidiaries, parent, employees, agents, legal representatives, and assigns, (collectively hereinafter referred to herein as "Company") a nonexclusive, fully transferable, perpetual, worldwide, license to use, reuse, disseminate, transfer, publish, and republish photographic portraits and pictures of myself included in whole or in part, in composite or distorted character or form, without restriction as to changes and alterations and do hereby give permission for Company to publish my name and other personal information that I supply to Company for "Cops Calendar" and in any media now known or hereafter devised for news, illustration, promotion, art, advertising, trade, or any other purpose whatsoever. I hereby grant to Company all rights to sublicense or transfer any rights provided under this Agreement. I hereby waive any right that I may have to inspect or approve the finished product in the advertising or editorial copy or other materials that may be used in connection therewith. I hereby release, discharge, and agree to save Company harmless from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur in any publication. I hereby waive any and all publicity rights, privacy rights, and all causes of action against Company in connection with the use by Company of these rights described herein. I hereby represent and warrant that I have the rights to grant the license herein and that Company's use of any photographs will not infringe the copyright or other rights of any third party. I have fully read this Agreement prior to its execution, am fully familiar with its contents and consent to its execution.
   I agree to to the terms described above.