AQK Media Release Form

Authorization and Release Agreement
Name*

PrefixFirst NameMiddle NameLast NameSuffix
Fraternal Name*
Fratneral Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@alphaomegakappa.org
Date of birth*

MonthDayYear
Date
This media release required for all active members and is for Alpha Omega Kappa Fraternity, Inc. If you do not want to be featured on any fraternal marketing materials please check the last box.
I wish to be featured in our marketing materials.

I allow Alpha Omega Kappa Fraternity, Inc. to take or capture my photos and videos at events, meetings, community service etc.I understand that all photos and videos that will be taken are copyrighted by Alpha Omega Kappa Fraternity, Inc.I understand that I will not receive any monetary compensation.I authorize Alpha Omega Kappa Fraternity, Inc. to distribute and reproduce the materials for the following purposes: advertising, marketing, branding, educational, digital promotions, internet videos, online courses, media, other commercial or non-commercial purposesI grant Alpha Omega Kappa Fraternity, Inc. to use my photos and videos on AlphaOmegaKappa.org, Youtube, Vimeo, Facebook, Twitter, Instagram, and other social media platform.I release Alpha Omega Kappa Fraternity, Inc. from all liability and obligations from any claim for injury, illnesses, claims, or demands.I, the undersigned, hereby agreed that I have read this agreement and bounded by it.
I do not wish to be featured at all.

I do not allow Alpha Omega Kappa Fraternity, Inc. to take or capture my photos and videos at events, meetings, community service etc.I understand that I will be asked to step aside when marketing photos are being taken.I release Alpha Omega Kappa Fraternity, Inc. from all liability and obligations from any claim for injury, illnesses, claims, or demands.I, the undersigned, hereby agreed that we have read this agreement and bounded by it.
Signature*

Clear
Date Signed*

MonthDayYear
Date
Should be Empty:

Authorization and Release Agreement