Emergency Contact: First Name* Last Name* Phone Number* Relationship *
I, First Name Last Name , hereby give permission to the Utah AIDS Foundation, its representatives and employees the right to take photographic images of me, film/video footage of me, or sound recordings of my voice. I authorize the Utah AIDS Foundation, its assigns and transferees to copyright, use, and publish the same in print and/or electronically.I understand that I will not receive remuneration of any kind.Moreover, I hereby waive claim to any rights, residuals, fees or other charges in connection with photographs, film/video footage or sound recordings with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. The Utah AIDS Foundation greatly appreciates your participation.Signature No, I prefer UAF not use any photo, film/video, or sound recordings of me.