By recording my video and/or audio testimonial with VocalVideo and Legal Aid of North Carolina about my lived experience as a Social Security claimant or beneficiary, I enter into the following agreement (“Agreement”) with Legal Aid of North Carolina (“LANC”).
I understand that LANC and its designees are collecting video recordings, audio recordings, written statements, and photographs of Social Security applicants/beneficiaries for their Social Security lived experience project. I understand and agree that my name, likeness, image, voice, appearance, and/or performance may be part of the recording, writing, and/or photographs.
I grant LANC and its designees the right to use the video recordings, audio recordings, written statements, and photographs in any format, now known or later developed. I grant, without limitation, the right for LANC and its designees to edit or duplicate, and use or re-use, the video recordings, audio recordings, written statement, and photographs in whole or in part, and alone or with other products, for any purpose that LANC and its designees determine.
I understand and agree that LANC and its designees may seek to share my story with the public, including with the press, online, and on social media, as long as my direct participation is not required.
I understand and agree that LANC may contact me about future opportunities to speak publicly about my story and I can decide which opportunities I can participate in and I can decide what I want to share during any conversation with LANC, the press, or other members of the public.
I understand and agree that participation in this project does not constitute the formation of an attorney/client relationship or agreement to represent participant in any legal action.
I understand that if I am a current or former client of LANC, the facts of my case are privileged and confidential under law and that I do not have any obligation to permit their disclosure. I understand and agree that if I included such information in my video and/or audio testimonial for purposes of this project that I agree to permit such disclosure knowing that I am not required to do so.
I understand and agree that LANC has no financial commitment or obligations to me as a result of this video, audio, image, or writing.
I have read, I understand, and I agree to all of the above, I agree to permit the disclosures specified knowing that I am not required to do so. I understand that I can revoke any part of this Agreement at any time by submitting a written revocation to brianh2@legalaidnc.org and/or Brian P. Hogan, Supervising Attorney, Legal Aid of North Carolina, 122 N Elm St Suite #700, Greensboro, NC, 27401.
Your voice matters. Thank you for considering this opportunity to share your story on behalf of LANC. By sharing your story, you play a powerful role in making the voices of Social Security claimants and beneficiaries heard .
