ELMNT FM Guest Form September 9, 2019February 21, 2020 ELMNT If you are human, leave this field blank.You are booked during our one-hour live talk show, Moment of Truth on ELMNT FM, streaming live in 106.5 Toronto and 95.7 Ottawa. Due to COVID-19, All of our scheduled interviews will be conducted over ZOOM. Our team will contact you in regards to setting up. MUSIC (Artists): If you are submitting your own music to be played during the show, please be sure we have a copy one week prior to the show so that it can be properly registered in our system. Please have this form sent back to us one week before your scheduled interview. TORONTO Corus building 25 Dockside Drive Toronto, Ontario M5A 0B5 Telephone: 416-481-2292NameEmailPhonePERSONAL RELEASE FORM TO: FIRST PEOPLES RADIO INC. (“FPR”) I hereby agree to be interviewed, photographed and audio/visually recorded by FPR for the purposes of its programming. FPR may use my name, voice, image and likeness, and may produce, reproduce and communicate to the public any recording, soundtrack, photograph, film or footage of me, including any performance by me (“Recording”), for the purposes of its programming and the promotion thereof. Included in the Recording and the rights granted herein, may be any recording of any artistic or musical work, and/or performance thereof, or a portion of any such work, I may have created and permitted FPR to record. FPR may edit, adapt, juxtapose and translate the Recording as it requires. I understand that the copyright in the Recording and in the programming will be owned by FPR, and that FPR (and its licensees and assignees) may communicate to the public, exhibit and distribute the Recording through all channels of media and by all methods of distribution or transmission now known or developed in the future, throughout the world, forever. I hereby agree, at the request of FPR, to execute and deliver such further documents and to perform and cause to be performed such further acts as may be reasonably required to register the entitlement granted hereunder. I hereby waive, release and discharge, and covenant not to bring any action to pursue, any and all claims whatsoever against FPR (including its parent, subsidiary, and affiliate companies, and all respective directors, employees, and agents thereof, and also including any of FPR’s licensees, successors and assigns), in connection with use, public communication and reproduction of the Recording as described above, including, without limitation, any claim for compensation, invasion of my privacy, infringement of my right of personality, defamation, infringement of my moral rights (which are hereby waived in favour of FPR and its licensees or assigns) or infringement of any other personal or property rights. I acknowledge that FPR is proceeding with the Recording and the use thereof as described above, in reliance upon this Release. I am referred to as the “Participant” below.Checkbox *AgreeDo Not AgreeCaptcha *reCAPTCHA Public Key not found. Both Public and Private keys must be set in order for reCAPTCHA to function.Submit