Photo Submission and Photo Use Release Form

I, hereby grant and authorize the Lake Cushman Maintenance Company the right to
take, edit, alter, copy, exhibit, publish, distribute and make use of any and
all pictures or video taken and submitted by me to be used in and/or for
legally promotional materials including, but not limited to, newsletters, flyers,
posters, brochures, advertisements, fundraising letters, annual reports, press kits
and submissions to journalists, websites, social networking sites and other print
and digital communications, without payment or any other consideration.


This authorization extends to all languages, media, formats, and markets now
known or hereafter devised. This authorization shall continue indefinitely
unless I otherwise revoke said authorization in writing. The revocation will
not affect any actions taken before the receipt of this written notification.


I understand and agree that these materials shall become the property of the
Lake Cushman Maintenance Company and will not be returned.


I hereby hold harmless, and release The Lake Cushman Maintenance Company
from all liability, petitions, and causes of action which I, my heirs, representative,
executors, administrators, or any other persons may make while acting on my behalf
or on behalf of my estate.


I warrant that I am of the age of consent (18 years or older) and that I
am competent to contract in my own name. I have read this release before
signing below and I fully understand the contents, meaning and impact of this
release.



Name:*
Division / Lot:*
Email:*
Consent 1:
Consent 1 Agreement:*
Consent 2:
Consent 2 Agreement:*
Consent 3:
Consent 3 Agreement:*
Consent 4:
Consent 4 Agreement:*
Signature instructions:
Signature:*
Date: *
Photo 1:*
Photo 2:
Photo 3:
Photo 4:
Photo 5:
Photo 6:
 

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