AUTHORIZATION FOR RELEASE OF NEWS ARTICLES OR PHOTOGRAPHS

AUTHORIZATION FOR RELEASE OF NEWS ARTICLES OR PHOTOGRAPHS
Various activities within the PRS organization may make the local newspaper, radio news, social media and other agency publications online or in print. PRS continuously tries to increase public involvement and awareness of the program. PRS will make a concerted effort to keep the public informed.

Your authorization is needed in order to use your name and photograph in any news coverage the program receives. This authorization shall continue in effect for the duration of time until you withdraw authorization.
Name*

First NameLast Name
Date*

MonthDayYear
Date
In an effort to increase positive public awareness of our services Plumas Rural Services, Inc. is hereby authorized to:
Use my name*

YesNo
Use my photograph*

YesNo
Signature*

Clear
Signature of Conservator, Guardian, Parent: (If appropriate)
Signature

Clear
Name of Conservator, Guardian, Parent

First NameLast Name
Should be Empty: