Photo Submission & Media Release Form

Photo Submission & Media Release Form

Mothers Against Drunk Driving Central Valley and Walk Like MADD CV
Name

First NameLast Name
Email
example@example.com
Phone Number
Age
The Media obtained shall be used for Mothers Against Drunk Driving Central Valley:

Video UseEmail blastsNewslettersBrochures or FlyersMagazinesWebsitesAll of the above
I, ______________, grants permission to Mothers Against Drunk Driving Central Valley, to use my media (photograph image and/or video footage and/or audio recordings).

I likewise understand that I may be identifiable from the reproduction of the media by Mothers Against Drunk Driving Central Valley indicated herein this agreement.

I hereby waive my rights to inspect or approve the media for production that may be used by Mothers Against Drunk Driving Central Valley for purposes stated herein, from hereon forward.

I likewise waive any right to royalties or any compensation arising from or related to the use of the image.
Attestation of Legal Age

I certify that I am of legal age and competent to contract in my own name. I have read this release before signing below and I fully understand the contents, terms, and the effect of this release.
Attestation of Parent/ Guardian

I am the parent or legal guardian of the named minor in this agreement. I have read this release before signing below, and I fully understand the contents, terms, and the effect of this release.
Date

MonthDayYear
Date
Signature

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MADD Central Valley is looking for photos of your loved ones, survivors and victims of DUI crashes, to remember and honor at community events such as the Tribute Area at Walk Like MADD. Please upload clear resolution photos below.

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If comfortable with sharing, please provide name, age/DOB, crash date and a few words about your loved one below.
Walk Like MADD CV 2024 (annual community fundraiser) is celebrating 15 years serving the Central Valley and is looking for photos you may have from past MADD events. Please upload clear resolution photos below.

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New this year at Walk Like MADD CV 2024 - Pet Relief Area! Our furry friends are a loyal, loving part of our family and we want them to be included! Please upload a clear resolution photo of your furry friend below.

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Name of your furry friend(s).
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