Photograph & Video Release Form - Liberty Chamber of Commerce

I hereby grant Liberty Area Chamber of Commerce permission to rights of my image, likeness and sound of my voice as recorded on audio or video tape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand this material may be used in diverse educational settings within an unrestricted geographic area and may be electronically displayed via the Internet. There is no time limit on the validity of this release.

Authorization*

I agree

By checking this box and typing my name below, I am electronically signing the photograph & video release form. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.

Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code

Phone*

Email*

Minor Release AUTHORIZATION*

I agree
Not applicable

Further, I attest that I am the parent or legal guardian of the child or children listed below and that I have full authority to consent and authorize Liberty Area Chamber of Commerce to use their likenesses and names.

Relationship to Child(ren)

Name(s) of Child(ren)