• UNITED WAY

    UNITED WAY

  • For the purpose, objective and work of United Way of York County, I hereby grant permission to United Way of York County for it's officers, agents and employees to take photographs and/or motion pictures of me, and to use my name in connection therewith, or in connection with any news release, publication or story. In granting such permission, I hereby relinquish any right, title or interest in such photographs, motion pictures, news releases, publications or stories. In signing this release I am attesting that I am not a party to any legal action that could jeopardize United Way of York County's purpose, objective and work and that all information I have stated, to my knowledge, is true and accurate.

  • Signatures: (Subject's signature if subject is over 18 years of age, signatures of a parent or legal guardian if subject is under 18 years of age

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  • Should be Empty: