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GSA Network Photo Release Form

Program Name and Date:

By selecting yes, you hereby authorize GSA Network to reproduce your image, photograph or to be filmed, as part of this program, for publicity and fundraising purposes. Their photograph, image, or likeness may appear in either official materials including (but not limited to) brochures, websites, email blasts, or any other form of media and/or technology currently in existence or not yet developed. I understand that my/my child’s pictures and/or interview may be accessible to anyone with Internet access and may appear in local, statewide, national, and international print or television media.

Yes

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Timestamp

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July 15, 2020 3:12 pm PST

GSA Network Photo Release Form Uploaded by Anna Davis - adavis@gsanetwork.org IP 2601:c7:4200:1090:2d4d:e9a7:501f:95a8