Tell us about yourself. (E.g., What city/town do you live in, family life, work life, etc.).
How did you first hear about radon and the impact it has on lung health?
Why did you test your home/workplace for radon?
Why did you decide to reduce the radon in your home/workplace? (If relevant)
Breathe Story Release Form
I hereby grant The Lung Association, Saskatchewan and its respective affiliates, designees and assigns my irrevocable permission to use and reproduce without compensation, my interview (or any portion thereof) if applicable, or any other appearance of any kind whatsoever (“Appearance”) and/or my name and likeness, as photographed, videoed, taped or otherwise recorded by The Lung Association, Saskatchewan or , in any future publicity, promotion or marketing in any manner and in all media whether now known or unknown, in perpetuity.
I agree that The Lung Association, Saskatchewan shall exclusively own all images, footage or other recording of my Appearance and that they are entitled to edit the forgoing in their sole discretion as they may deem appropriate.
I agree that I will not use any images, footage, or other recording of my Appearance at any time without first receiving written permission from The Lung Association. Requests of this nature shall be made no earlier than one month after the date of the Appearance and or at the end of the event (above) it is acknowledged The Lung Association may decline this request for whatever reason they see fit.
I release The Lung Association, Saskatchewan and those who get their rights from or through The Lung Association, Saskatchewan from any claims or actions I may make arising out of the use of my Appearance and/or my name and likeness in the promotion, production, broadcast and exploitation of such promotion.
I declare that:
I have reached the age of majority in my province or territory of residence; or, if I have not reached the age of majority in my province or territory of residence, my parent, guardian or other authorized legal representative has signed this Agreement to indicate his/her consent on my behalf to the terms of this Agreement.
The terms of this Agreement and all rights and obligations hereunder are personal to me and may not be assigned or assumed by any third party.
This Agreement and all rights hereunder may be freely assigned, in whole or in part, by The Lung Association, Saskatchewan to any party, and in the event of any such assignment, this Agreement shall remain binding upon me.