Video Submission Form

Submit a Video
Submit your video for evaluation
Name
First NameLast Name
Phone Number
Area CodePhone Number
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Birth Date
MonthDayYear
2 digit month, 2 digit day, 4 digit year1
E-mail
Make sure your video is no longer than 1 minute.
Make sure you own the right to use all music & images on the video.
Must be 18 years or older. Minors must have parent or guardian permission for submissions.
Do You Agree to the Terms Above?
Upload Video
Upload a File
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*I do hereby consent to the use by The Hecklers Lounge of my image, video, voice, or all three of them, in the item described above. In addition, I waive any right to inspect or approve the finished video recording. I agree that all such pictures, video or audio recordings and any reproduction thereof shall remain the property of The Hecklers Lounge and that The Hecklers Lounge may use it as it sees fit. I understand that this consent is perpetual, that I may not revoke it, and that it is binding. I understand that these images may appear publicly and/or on the internet. It is understood that this material will be used in a legitimate manner, both internally and outside and is not intended to cause any harm or undue embarrassment to the parties involved.
Signature
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Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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Submit a Video