MTMF Photo and Media Release Waiver Form
Please read the waiver carefully and provide your signature to grant permission for photo and media use.
Full Name
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First Name
Last Name
Photo and Media Release Waiver Statement
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Moments to Memories Fund P.O. Box 58, Tenafly, NJ 07670 tickets@momentstomemoriesfund.org I, the undersigned, hereby grant Moments to Memories Fund, its representatives, affiliates, employees, agents, successors, and assigns (collectively, “the Organization”), the absolute and irrevocable right and permission to use, publish, and distribute photographs, video recordings, or other media that include my image, likeness, voice, name, or any statements made by me, in whole or in part, for use in any of the Organization’s promotional materials, including but not limited to: ● Social media posts ● Print publications and brochures ● Fundraising or marketing campaigns ● Newsletters and public relations materials ● The Organization’s website or third-party nonprofit platforms I understand that: ● These materials may be used without time limitation or geographic restriction. ● I will not receive any form of compensation for the use of my image or media likeness. ● I may revoke this consent only in writing, and such revocation shall not apply retroactively. I hereby waive and release any claims, demands, or causes of action, including invasion of privacy, right of publicity, defamation, or any similar claims, that may arise out of or relate to the use of these materials by the Organization.
Consent and Release for Use of Image and Likeness
Signature
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Date of Signature
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email Address
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example@example.com
I have read and agree to the terms of the Photo and Media Release Waiver.
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Submit
Submit
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