Qapital Interview Consent Form

Research Study Terms and Conditions

By scheduling a call time in response to an offer to participate made to me by Qapital, LLC (“Qapital”), or by otherwise initiating any participation, in a research study (the “Research Study”) that is sponsored and conducted by Qapital, I acknowledge and agree to the entirety of these Research Study Terms and Conditions (these “Terms”). In exchange for the opportunity to participate in the Research Study, the payment I am to receive hereunder and other good and valuable consideration, the receipt of which is hereby acknowledged, I hereby irrevocably and unconditionally covenant and agree with Qapital, for myself and my heirs, estate, insurers, successors and assigns, as follows:

1. Purpose. I have been informed that:

(a) Qapital is conducting a marketing research study by hosting the Research Study, and my participation therein is completely voluntary and unrelated to my use of the Qapital app, if any;
(b) The opinions and experiences of our Research Study participants are important to the research of Qapital to better understand its and its affiliates’ customers and plan its product development.
(c) Qapital plans to use this information to understand how to enhance Qapital’s products and services and improve performance.

2. Release from Liability and Covenant Not to Sue.

I FULLY AND FOREVER RELEASE AND DISCHARGE QAPITAL AND ITS PARENTS, SUBSIDIARIES, AFFILIATES, DIRECTORS, OFFICERS, SHAREHOLDERS, EMPLOYEES, AGENTS, AND INSURERS (EACH, A “RELEASED PARTY”, AND COLLECTIVELY, “RELEASED PARTIES”) FROM ANY AND ALL INJURIES (INCLUDING BUT NOT LIMITED TO DEATH), LOSSES, DAMAGES, CLAIMS (INCLUDING BUT NOT LIMITED TO NEGLIGENCE CLAIMS), DEMANDS, LAWSUITS, EXPENSES, AND ANY OTHER LIABILITY OF ANY KIND, OF OR TO ME, MY PROPERTY, OR ANY OTHER PERSON, DIRECTLY OR INDIRECTLY ARISING OUT OF OR IN CONNECTION WITH MY PARTICIPATION IN THE RESEARCH STUDY, EVEN IF IT IS DUE TO THE NEGLIGENCE, INJUDICIOUS ACT, OMISSION, OR OTHER FAULT OF A RELEASED PARTY. I COVENANT NOT TO MAKE OR BRING ANY SUCH CLAIM AGAINST THE COMPANY OR ANY OTHER RELEASED PARTY, AND FOREVER RELEASE AND DISCHARGE THE COMPANY AND ALL OTHER RELEASED PARTIES FROM LIABILITY UNDER SUCH CLAIMS.

3. Indemnification.

I INDEMNIFY, DEFEND, AND HOLD HARMLESS QAPITAL AND THE OTHER RELEASED PARTIES FROM AND AGAINST ANY AND ALL LOSSES, EXPENSES, DAMAGES, AND COSTS, INCLUDING BUT NOT LIMITED TO REASONABLE ATTORNEYS’ FEES, ARISING FROM OR RELATING TO MY PARTICIPATION HEREUNDER, INCLUDING BUT NOT LIMITED TO MY BREACH OF ANY PROVISION OF THESE TERMS. I shall use my best efforts to cooperate in the defense of any claim. I acknowledge that Qapital reserves the right, at its own expense, to employ separate counsel and assume the exclusive defense and control of any matter otherwise subject to indemnification under these Terms.

4. Authorization to Use Image and Feedback.

Qapital and others may photograph, film, videotape, or otherwise record the Research Study. I hereby grant to Qapital and the other Released Parties the right in perpetuity and throughout the world, with no further compensation to me, to use my photograph, video, or film portrayal, audio recording, image, voice, avatar, name, biographical data, silhouette, body dimension, shape, posture, or any other personal characteristic or physical or vocal likeness, or any materials based on or derived from these materials, for product development or research purposes. I shall have no right of approval and I WAIVE ANY CLAIM (INCLUDING, WITHOUT LIMITATION, CLAIMS BASED ON INVASION OF PRIVACY, DEFAMATION, AND RIGHT OF PUBLICITY) ARISING OUT OF ANY USE, BLURRING, ALTERATION, DISTORTION, ILLUSIONARY EFFECT, OR ANY USE IN COMPOSITE FOR OF MY NAME, PICTURE, LIKENESS, VOICE, OR BIOGRAPHICAL INFORMATION FOR THE PERMITTED PURPOSES. The Released Parties shall have no obligation to use any of the rights I grant. I represent that it is unnecessary for any Released Party to obtain permission from or to pay any third party in connection with the rights granted in this paragraph.

5. Assignment of Intellectual Property Rights and License to Use Comments, Feedback, and Ideas.

For no additional consideration beyond that described in Section 11 and the opportunity given by Qapital to participate in the Research Study, I hereby grant to Qapital a perpetual, irrevocable, worldwide, royalty-free license to use all comments, feedback, and ideas I may share with them, without notice or acknowledgment to me, for any purposes whatsoever, including, but not limited to, developing, manufacturing, and marketing products and services and creating, modifying, or improving products and services. I hereby assign to Qapital all rights, title, and interest I may have or develop to inventions that relate to my participation in the Research Study. Nothing herein shall require me to assign to Qapital inventions that do not relate to my participation in the Research Study.

6. Privacy Statement.

I acknowledge that I may provide information to Qapital in connection with my participation in the Research Study, including but not limited to my name, address, age, ideas, or feedback. Qapital uses this information to determine whether participants qualify for one or more research studies and for other research purposes. Qapital’s policy is to protect each participant’s privacy and confidential information subject to and in accordance with these Terms and applicable law. Qapital’s privacy policy contains additional information. I agree to respect the privacy of the other group members and keep anything said within the context of the discussion confidential. I acknowledge that information I provide in connection with the Research Study discussion may be disclosed:
(a) by third parties to whom I have disclosed the information, including, without limitation, other Research Study participants; or
(b) when requested by a governmental agency having jurisdiction, a court of competent jurisdiction, or other operation of law.

7. Confidentiality.

I understand that I may be exposed to information about Qapital’s products and services, advertising campaign, branding initiatives, and/or other aspects of Qapial’s business and ideas that may not have been disclosed to the public (collectively, the “Confidential Information”). I shall maintain the confidentiality of all Confidential Information disclosed to me in connection with the Research Study, and shall hold all Confidential Information in strict confidence. I further agree to refrain from disclosing or using Confidential Information for any purpose other than participating in the Research Study. The obligation to maintain the confidentiality of Confidential Information shall survive termination and continue for ten years.

8. Payment.

When I complete my participation in the Research Study, Qapital shall give me a $50 gift card from its partner provider TangoCard.com (“Tango”). I acknowledge and agree that my receipt of such consideration is subject to my agreement with Tango’s terms and conditions and privacy notice, which can be found on its website at https://www.tangocard.com/terms-of-service/ and https://www.tangocard.com/privacy-notice/, respectively.

9. Choice of Law.

This Agreement and all matters arising out of or relating to these Terms are governed by and construed in accordance with the laws of the State of New York without giving effect to the conflict of laws provisions thereof to the extent such principles or rules would require or permit the application of the laws of any jurisdiction other than those of the State of New York.

10. Dispute Resolution and Binding Arbitration.

(a) I AND QAPITAL EACH GIVE UP ANY RIGHTS TO LITIGATE CLAIMS IN A COURT OR BEFORE A JURY. I ACKNOWLEDGE THAT OTHER RIGHTS THAT I WOULD HAVE IF I WENT TO COURT MAY ALSO BE UNAVAILABLE OR MAY BE LIMITED IN ARBITRATION.
(b) ANY CLAIM, DISPUTE, OR CONTROVERSY (WHETHER IN CONTRACT, TORT OR OTHERWISE, WHETHER PRE-EXISTING, PRESENT, OR FUTURE, AND INCLUDING STATUTORY, CONSUMER PROTECTION, COMMON LAW, INTENTIONAL TORT, INJUNCTIVE, AND EQUITABLE CLAIMS) BETWEEN ME AND QAPITAL ARISING FROM OR RELATING IN ANY WAY TO MY PARTICIPATION IN THE RESEARCH STUDY WILL BE RESOLVED EXCLUSIVELY AND FINALLY BY BINDING ARBITRATION.
(c) The arbitration will be administered by the American Arbitration Association in accordance with the Consumer Arbitration Rules then in effect. The Federal Arbitration Act will govern the interpretation and enforcement of this section. The arbitration will take place in New York, NY.
(d) A single, mutually agreed arbitrator will have exclusive authority to resolve any dispute relating to the enforceability of this arbitration provision, including any unconscionability challenge or any other challenge that the arbitration provision or the Agreement is void, voidable, or otherwise invalid. The arbitrator will be empowered to grant whatever relief would be available in court under law or in equity. Any award of the arbitrator(s) will be final and binding on each of the parties, and may be entered as a judgment in any court of competent jurisdiction.

11. Questions.

I understand that I am free to ask questions at any time, and if I am not satisfied with the answers provided to me, then I may withdraw from this research study.

12. Withdrawal.

I can withdraw from the Research Study at any time, but I cannot terminate, cancel, or revoke these Terms for any reason. I acknowledge that Qapital can withhold compensation under Section 11 if I do not fully participate in the Research Study. Any such determination by Qapital is final.

13. Miscellaneous.

If any provision of these Terms is illegal or unenforceable under applicable law, the remainder of the provision will be amended to achieve as closely as possible the effect of the original term and all other provisions of these Terms will continue in full force and effect. This agreement supersedes any oral or written statements made by or to me in connection with the Research Study. This agreement may not be modified except by a written agreement that specifically refers to the provision or provisions to be amended and that is signed by an authorized representative of Qapital, following review by Qapital’s legal department. I am not an employee of or in a joint venture with Qapital or any other Released Party. I understand that my participation in the Research Study or my receipt of consideration under Section 11 does not form an employment relationship between me and Qapital or any other Released Party.

14. Informed Consent. I certify that I:

(a) am at least 18 years of age;
(b) have read and fully understand the above information;
(c) will not provide false or misleading information; and
(d) voluntarily agree to participate in this research study on the topic and date identified herein, in good faith and to the best of my ability.