Your Name:

Email Address:

Phone Number:

Address:

City: State: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zipcode:

Video Link:(example: http://www.youtube.com/video...)

Terms:
By filling out and submitting this release, I hereby give my full permission for the use of my name, picture, image, likeness, actions, voice, or other personally identifiable information, in whole or in part, individually or in conjunction with other images, as part of a video submission for the Launch User Created Content Contest.
I waive all rights of privacy or compensation, which I may have in connection with such use of my name, picture, image, likeness, actions, voice or other personally identifiable information. I grant Launch Tech USA and its officials, employees, representatives, agents, licensees, successors and assignees the irrevocable and unrestricted right to use my name, picture, image, likeness, actions, voice or other personally identifiable information associated with such video submission in all formats, media and in all manners, including composite or altered representations, for advertising, trade or any other lawful purposes.
I waive any right to inspect or approve the finished version(s), including written copy that may be created in connection with the video production, editing and promotion therewith.

[select] Yes, I am over 18 years old and I agree Yes, I am under 18 years old but I have parental permission and I agree No, I do not agree.