TELL US ABOUT YOUR CHAMP
CHAMPION FIRST NAME
CHAMPION LAST NAME
CHAMPION FULL NAME (As you would like shared on site)
DONATION PAGE (Optional)
SELECT YOUR STATE.
District of Columbia
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
CHAMPION'S STORY (1,200 Characters Max)
If filling out this form for someone else:
YOUR FIRST NAME
YOUR LAST NAME
I hereby irrevocably authorize Cupid Charities d/b/a Cupid's Charity to use photographic images of me and/or my property and authorize Cupid’s Charity, its assignees, licensees, legal representatives and transferees to use and publish (with or without my name) photographs, pictures, portraits or images, including those from the date of or about this Agreement, in any or all forms and media and in all manners including modified images for the purposes of advertising, publicity, illustration, publishing (including publishing in electronic form on CDs or Internet websites), for any publicity or informational or other lawful uses as may be determined by Cupid’s Charity. This agreement includes all audio and video recordings made by whatever means and their use on current and future distribution technology including social media. I agree there is no compensation to me. I permit Cupid’s Charity, referred to above, and its licenses or assignees, to use the photographs referred to and/or drawing therefrom and any other reproduction thereof, either complete or in part, alone or in conjunction with, and wording and/or drawings, solely and exclusively for advertising, editorial, public relations, media advertising, display material, website and Internet material. Such photographs and electronic forms may be used worldwide with no specific exclusions. All prints, digital originals and reproductions, CDs and videos shall constitute Cupid’s Charity property, solely and completely forever. I understand that I do not own the copyright(s) of the photograph(s) referred to in the document. I further waive any and all rights to review or approve any uses of the images, any written copy or finished product. I have read and fully understand the terms of this release and certify that I am of full age (18 years) and am of full legal capacity to execute the foregoing authorization. Individuals under 18 years old must have a parent or guardian sign the release.
I consent to the waiver above.
CHAMP'S PHOTO (JPEG, 700KB MAX FILE SIZE)
Please submit a square or vertically-oriented image if possible.