| Please PRINT and complete this form and bring it to the REGISTRATION table at the Cat Show | |||||
|
Media Release Form
I, (please print) _____________________________________, hereby grant permission to the Biomedical Communications Unit and to the College of Veterinary Medicine to create, copy, reproduce, exhibit, publish, or distribute any likeness of myself, my belongings, my children, or my animals to be used for the purpose of creating stock, promotional material for the College of Veterinary Medicine. I understand that the above uses may include, but are not limited to videotapes, films, sound recordings, photographs, displays, brochures, Web sites, multi-media programs, or any other type of promotional medium existing now or in the future. I further understand that by granting this permission I am irrevocably giving up all rights and claims to monetary compensation for any future uses of this material by BCU, the CVM, their subsidiaries, and successors.
|
|||||
| ________________________________________ |
________________________________________ |
||||
| Signature |
Witness |
||||
| ________________________________________ |
________________________________________ |
||||
| ________________________________________ |
Parent/Guardian (if under age 21) |
||||
| ________________________________________ | |||||
| Address | |||||
| ________________________________________ |
________________________________________ |
||||
| Phone |
Date |
||||
|
AAFP Cat Show -- April 28th 2001 For Office Use Only:
|
|||||