GSA Network

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.

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Signature Certificate
Document name: GSA Network Photo Release Form
lock iconUnique Document ID: a2c822b1f98a7c2f5934088c85e6b7e628b63c34
Timestamp Audit
July 15, 2020 3:12 pm PSTGSA Network Photo Release Form Uploaded by Anna Davis - IP 2601:c7:4200:1090:2d4d:e9a7:501f:95a8