Authorization + Release Information

I understand my testimonial, photograph or video likeness as outlined above (the "Testimonial") and made on behalf of Jodi Fedor/Baji Grace, Catalyst and Disruptive Radiance Inc. (hereinafter called "The Company") may be used in connection with publicizing and promoting The Company.

I authorize The Company to use my name, brief biographical information, and the Testimonial as defined on this form. I hereby irrevocably authorize The Company to copy, exhibit, publish or distribute the Testimonial, along with my photo, for purposes of publicizing The Company's programs or for any other lawful purpose. These statements may be used in printed publications, multimedia presentations, on websites or in any other distribution media. I agree that I will make no monetary or other claim against The Company for the use of the statement.


In addition, I waive any right to inspect or approve the finished product, including written copy, wherein my likeness or my testimonial appears.


I hereby hold harmless and release The Company from all claims, demands and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.


In consideration of my engagement as a model or example, upon the terms herewith stated, I hereby give to The Company, his/her heirs, legal representatives and assigns, those for whom the photographer is acting, and those acting with his/her authority and permission:


  1. the unrestricted right and permission to copyright and use, re-use, publish, and republish my testimonial statement and/or photograph and/or video that I submitted, in conjunction with my own or a fictitious name, or reproduction hereof in color or otherwise, made through any and all media now or hereafter known for illustration, art, promotion, advertising, trade, or any other purpose whatsoever.

b) I also permit the use of any printed material in connection therewith.


c) I also give my full and complete permission, without compensation or limitation to the company to take, record, publish, display or obtain the testimonials or other statements I submitted in any media by any means methods including, but not limited to, advertising, marketing, and promotional materials. I understand and agree that the statements may be used, reproduced, re-used, edited, or changed with or without identifying me and my affiliation.


d) I hereby relinquish any right that I may have to examine or approve the completed product or products or the advertising copy or printed matter that may be used in conjunction therewith or the use to which it may be applied.


e) I hereby release, discharge and agree to save harmless Jodi Fedor, the videographer/photographer/coordinator/retreat leader and/or anyone else involved in the garnering of this testimonial, his/her heirs, legal representatives or assigns, and all persons functioning under his/her permission or authority, or those for whom he/she is functioning, from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form whether intentional or otherwise, that may occur or be produced in the taking of said picture or in any subsequent processing thereof, as well as any publication thereof, including without limitation any claims for libel or invasion of privacy.


f) I hereby affirm that I am over the age of majority and have the right to contract in my own name. I have read the above authorization, release and agreement, prior to its execution;  fully understand the contents thereof. This agreement shall be binding upon me and my heirs, legal representatives and assigns.

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Credits: Bastein Hervé, Lera Lazara, Poyan Shifter. Background in several photos: David Seligman Design