Photo Release Form
KLAEIDOSCOPE OF KEUKA
Member Information
Full Name
First Name
Last Name
Email
example@example.com
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Photographer's Name
First Name
Last Name
Number of Photos Submitted
Photo Names/Additional Information
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Authorization and Release Agreement
I give the Keuka Lake Association (KLA) permission to use my photograph(s) or digital image(s) in the KLAeidoscope of Keuka collection. In addition, I agree that the KLA has the right to reproduce the photographs for display on the KLA website, in KLA newsletter or printed materials or for informational or promotional purposes for the KLA. I confirm that the photograph or image I submitted represents my original work and I will not receive.
I grant KLA permission to use my photos and videos on Youtube, Vimeo, Facebook, Twitter, Instagram, and other social media platform.
I understand that I will/ will not receive any monetary compensation.
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