National Library of Medicine Video Contest Certification Form

“NLM & You: The Video”

 Please read and follow all NLM Video Contest entry rules at 

By clicking on the submit button, I certify the following:

  • I am the creator of the video titled above. (Note for videos having more than one creator, each creator must complete and submit his/her own form.)
  • I have read and agree to the contest rules listed at: 
  • I am at least 13 years of age, and if under 18 years of age, I have my parent or guardian’s permission to enter and use my likeness in this contest.
  • Neither I nor any member of my immediate family is an NIH or NLM employee or contractor.
  • I hereby grant NLM a non-exclusive, royalty free, irrevocable license to reproduce, distribute, modify, create derivative works from, display, and perform publicly and otherwise use, and authorize others to use, my video or derivatives thereof for any Federal purpose throughout the world and in any media.
  • NLM has my permission to photograph, record, retain, and use my likeness or voice in connection with this contest and for Federal purposes.  NLM or its collaborators or contractors may use or reproduce my likeness or voice in all media or materials that it considers appropriate. Because I understand that NLM may, relying on my permission, commit significant resources to produce materials that may include my likeness or voice, I agree that my permission cannot be revoked. 
  • I have obtained written permission from everyone seen or heard in my video to use their likeness.  If people seen or heard in the video are under 18 years old, I also obtained their parent or guardian’s permission and signature.  I understand that it is a condition of this contest that these written permissions will be provided to NLM upon request.
  • I understand and agree that the materials provided to enter this contest will become the property of the National Library of Medicine and will not be returned.
  • I attest that all statements made in the video are true to the best of my knowledge.