Photography Entry Form

Photography Entry Form
Your Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Description of Entry*
File Upload*

Upload your photo here
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RELEASE DISCLOSURE

I hereby grant Freedom Ag & Energy permission to use my name and likeness in a photograph in any of its publications, including website and social media, without payment or any other consideration. I understand and agree that these materials will become the property of Freedom Ag & Energy and will not be returned. I hereby irrevocably authorize Freedom Ag & Energy to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing Freedom Ag & Energy’s products or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge Freedom Ag & Energy from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have because of this authorization. I am 18 years of age and am competent to contract in my own name. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.
Signature*

Clear
Signature Date*
If under 18, Parent or Guardian Signature

Clear
Parent or Guardian Signature Date
Should be Empty:

Your Information