GLOW Project Movie Public Screening License Agreement Any public broadcast or screening of the GLOW Project movie is strictly prohibited without an approved and signed License Agreement from Within GLOW, LLC, the copyright owner. This License Agreement sets forth the terms for which approval is given to: First Name: Organization: Last Name: Daytime Phone: ( ) Cell: ( ) Fax: ( ) Primary Email Screening Event Details: Date of Screening: Name of Venue: Venue Contact: Address of Venue: Phone: ( ) Fax: ( ) Number of Seats at Venue: Are you charging a ticket fee? Yes No Public Screening License Agreement page 1 of 5 3/11/2009
Event Type (please check one): Fundraising event for not-for-profit organization Name of organization: W-9 Form to be filled out by organization and attached to this document. Taxpayer ID number: State of Incorporation: Business/social event Name of business or social organization: School/University/College Name of School: Other Please Name: Movie License Fee: $1,250.00* $ 750.00* If your organization is not-for-profit or a school *Waived License Fee Option: If purchasing 75 or more GLOW Project movie DVDs, the Screening License Fee is waived. DVDs will be discounted at $5.00 off the $29.95 retail price and sold at $24.95, only if purchasing a quantity of 75 or more. Shipping and handling fees will be added. (Please state the quantity of DVDs you will purchase below) We will purchase GLOW Project DVDs @ $24.95 each. We understand that the Screening License Fee will be waived if 75 or more DVDs are purchased. We also understand that we will be charged for shipping and handling of the DVDs via standard UPS ground rates. Please be advised that all purchases are non-refundable. Dates and location of screening may be changed with prior written notice to Within GLOW, LLC and only provided that the date change does not conflict with another GLOW Project movie screening event. This License Agreement is for one screening of the GLOW Project movie. Any other use/showing of the GLOW Project movie, without the prior express written consent of Within Glow, LLC, and the payment of the then applicable License Fee (which is subject to change at the discretion of Within Glow, LLC), is strictly prohibited. Licensee is granted with no rights to the ownership of the copyrighted materials contained in the GLOW Project movie DVDs. The license granted herein is nonexclusive, non-sub-licensable or transferable, and Licensee is granted with no rights to modify or use any of the materials contained in the GLOW Project copyrighted materials or any trademarks or other intellectual property rights with respect to the GLOW Project, except as specifically set forth in this License Agreement. Licensee is not authorized to reproduce the copyrighted work or any intellectual property rights in and to the trademarks of the GLOW Project in any manner nor to prepare derivative works based upon the copyrighted work. Licensee will not knowingly, nor will it encourage or assist a third party to challenge the validity or ownership of any copyright, trademark or other intellectual property right of Within Glow, LLC or any of its affiliates. In addition, Licensee will not utilize the trademarks or copyrighted materials of Within Glow, LLC or its affiliates, in any manner that would diminish its value or harm the reputation of Within Glow, LLC. Public Screening License Agreement page 2 of 5 3/11/2009
This License Agreement does not constitute either party as the agent of the other, or create a partnership, joint venture or similar relationship between the parties. This Agreement shall be governed by and shall be construed in accordance with the law of the State of Texas. Each party acknowledges and agrees that the state or federal courts located in Texas will have sole and exclusive jurisdiction over any cause of action that arises under this License Agreement. This License Agreement is intended to be the sole and complete statement of obligation of the parties as the subject matter hereof and supersedes all previous understandings, negotiations and proposals as to such subject matter. Required Authorized Signatures: Licensee Signature: Date: Business/Group Name: License is not granted unless this agreement is countersigned by a representative of Within GLOW, LLC. Within Glow, LLC Signature: Date: Please complete the Payment Authorization Form beginning on the following page. Public Screening License Agreement page 3 of 5 3/11/2009
Movie Screening Payment Authorization Form Authorized Signature: Company Name: City: State/Province Postal Code: Telephone: Ext: Email: License being purchased: $1,250.00 screening Not-for-profit organization or school screening $750.00 No screening fee/dvd purchase option: I am purchasing 75 or more DVDs to have my license fee waived. Please charge for DVDs at a cost of $24.95 (a $5 savings) per DVD, plus UPS standard ground shipping & handling. I understand that by purchasing 75 or more DVDs at this quantity-discount price, I will not be charged a screening license fee. Furthermore, if my order is for 150 or more DVDs, please send them with FREE shipping and handling! 10% on 10 or more quantity-discount option: I am purchasing less than 75 but more than 9 DVDs. Please charge for DVDs at a cost of $26.95 (a $3 savings) per DVD, plus UPS standard ground shipping & handling, plus the applicable screening license fee indicated above. Choose payment option: Credit Card or Check Pay by credit card: Authorize charges to your credit card. American Express Visa MasterCard Discover Credit card number Exp. Date Print Cardholder s Name as it appears on the card CVV # on front/back of card Address that the credit card is billed to: X Signature of Cardholder Public Screening License Agreement page 4 of 5 3/11/2009
Pay by check: Authorize electronic checks on your U.S. bank account. Business checking Checking Savings Name as it appears on check Name of Bank as it appears on check Routing Number (9 digits) Account Number X Signature of Bank Account Owner If purchasing DVDs, please provide your shipping information. Ship to (Please print clearly): Attention of: Company Name (if applicable): Address (cannot ship to a P.O. box): City: State/Province: Postal code: Telephone: ( ) Alternate: ( ) Email: Fax all 5 pages of this agreement to (972) 720-9995 Attn: Event Services Be sure to include any required attachments. If you have questions, please contact Jenn Simpson at 972-620-9995 ext. 1000 Public Screening License Agreement page 5 of 5 3/11/2009