Photograph & Video Release Form
Photographic, audio or video recordings may be used for the following purposes:
- conference presentations
- educational presentations or courses
- informational presentations
- on-line educational courses
- educational videos
By signing this release I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet or in the public educational setting.
I will be consulted about the use of the photographs or video recording for any purpose other than those listed above.
There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.
This release applies to photographic, audio or video recordings collected as part of the sessions listed on this document only.
By signing this form I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes.
Full Name___________________________________________________
Street Address/P.O. Box________________________________________
City ________________________________________________________
Postal Code/Zip Code______________________________________
Email Address________________________________________________
Signature____________________________ Date____________________________
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