AMERICAN READING FORUM

PHOTO RELEASE FORM

Date __________________

I hereby grant American Reading Forum permission to use my likeness in photograph(s)/video in any and all of its publications and in any and all other media, including the World Wide Web site, whether now known or hereafter existing, controlled by American Reading Forum, in perpetuity and without further consideration. I have had an opportunity to examine the photograph that will be used and do not find it objectionable.

I acknowledge the American Reading Forum’s right to crop or treat the photograph at its discretion. I hereby waive any right to inspect or approve the photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the photographs.

I also understand that once my image is posted on the American Reading Forum’s website, the image can be downloaded by any computer user. I also acknowledge that the American Reading Forum may choose not to use my photo at this time, but may do so at its own discretion at a later date.

I release the American Reading Forum, its Board of Directors, and its members from liability for any claims by me or any third party in connection for the use the photograph(s)/video.

Name (print full name) ___________________________________

Signature _____________________________________________

Relation to subject (if subject is a minor) _____________________

Address ______________________________________________

City, state, zip __________________________________________

Telephone ____________________________________________

Fax __________________________________________________

E-mail ________________________________________________

Return this form by email to Gary Moorman at moormangp@appstate.edu

Or by mail at: Gary Moorman

Department of LRE

Box 32085

Boone NC 28608