Press Media Image Use Authorization

Date:

I authorize the use and reproduction by ___________________________ (Organization/Publication) of any and all photographs and images taken of me in connection with media coverage, publications, or releases.

Name of Subject: Contact Information:

Description of Image(s):

I understand that these images may be used for editorial, promotional, and informational purposes in print, online, or other media formats, and I waive any right to inspect or approve the finished product.

Signature:

Date Signed:

If under 18, Parent/Guardian Name: Signature: Date: