Gateway Mural Project: Mar Vista Community Magic Medley Mural Portrait Submission Form

Gateway Mural Project: Mar Vista Community Magic Medley

Submit a local hero, legend, neighbor, loved one, or landmark of Mar Vista for consideration to be included in an upcoming mural below!
Your Name

First NameLast Name
Your Email
example@example.com
Your Phone Number
Please enter a valid phone number.
Name of Person Submitted (If Anonymous, write that or a pseudonym)

First NameLast Name
Submitted Person's Email (if N/A, put that)
example@example.com
Submitted Person's Phone Number (if N/A, put that)
Please enter a valid phone number.
Why did you submit this individual?
What is this person's connection to Mar Vista?
Does this individual have a connection to any of the following? Select any/all that apply:

Ocean View Farms Community GardenMar Vista Farmer's Market or other local businessesThe arts and music culture scene of Mar VistaFirst Responders, Fire Station 62Olympics 2028 (Athletes with ties to Mar Vista or L.A.)
How has this person contributed to the city and/or community of Mar Vista?
Upload photos of person submitted or documents related to submission here:

Upload photos or files related to this submission here
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Permission to Use Photograph

I, the undersigned, hereby grant Julia Fordyce Art the absolute right and permission to use my photograph(s) in any manner or media, including, but not limited to, the following purposes:

Mural Design Reference
Publications
Advertising and promotional materials
Social media platforms
Websites
Press releases

No Compensation

I understand that I will not receive any monetary compensation for the use of my photograph(s).

Rights Granted

I grant Julia Fordyce Art the following rights:

The right to edit, alter, copy, or distribute the photograph(s) for any lawful purpose.
The right to use my name or a psuedonym, if chosen, in connection with the photograph(s) if they choose.

Release and Waiver

I hereby release and discharge Julia Fordyce Art, its employees, agents, and representatives from any and all claims, demands, or causes of action that I may have now or in the future for defamation, invasion of privacy, or violation of the right of publicity or any other right arising out of or relating to the use of the photograph(s)
By signing below, I acknowledge that I have read and understood this Permission to Use Photo Release Form and agree to the terms and conditions stated above.

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