Universal School Meals PA Release Form

Thank you for your continued support for the School Nutrition Association of Pennsylvania (SNAPA) and Universal School Meals PA. Your engagement and voice are crucial to our advocacy efforts. By filling out this form, you authorize our campaign for universal school meals in Pennsylvania to use your name, image, likeness and biographic information in any medium without limitation, including print, social media, and the World Wide Web, for any lawful purpose. Please look at the options below and fill out only those sections where you agree to participate in this important endeavor. Leave any space blank where you do not want to participate.

Name*

PrefixFirst NameLast NameSuffix

Title *

District or Organization*

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Headshot: I will provide SNAPA and the Universal School Meals PA Coalition with my headshot, or another submitted image, for use in social media posts, website placement or other printed marketing material for advocacy, with the use of my biographical information, above.*

YesNot at this time

Headshot Upload

You can send at a later time if needed.

Quote: I agree to provide SNAPA and the Universal School Meals PA Coalition with a quote expressing my support for this important initiative, or review and approve a submitted quote, for use in social media posts, website placement or other printed marketing material for advocacy, with the use of my biographical information, above.*

YesNot at this time

Quote

You can send at a later time if needed.

Media: I agree to work with SNAPA and the Universal School Meals PA Coalition to place letters to the editor or guest opinion pieces in my local newspaper under my name. I understand that the content of these pieces will be shared with me in advance, and none will be submitted without my review and approval.*

YesNot at this time

Interviews: I agree to work with SNAPA and the Universal School Meals PA Coalition on potential interviews with reporters for earned media stories in local news outlets, including print, broadcast, online, etc.*

YesNot at this time

Correspondence: I agree to work with SNAPA and the Universal School Meals PA Coalition to craft letters and/or e-mails of support to my local legislators. I understand that the content of these pieces will be shared with me in advance, and none will be sent without my review and approval.*

YesNot at this time

Please verify that you are human*

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