Reset form authorization for media release photograph, video, or interview this form collects information that is not part of the medical record. for local storage only. story name publication date (month dd, y) physician name public affairs staff...
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Documentary interview release form my signature below will confirm my agreement with (hereafter artist), his/her legal representatives and assigns, course instructor and university at buffalo (ub) regarding the disposition of audio and/or video...
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Food bank of the rockies photo, video & interview release please print or type info of person/s in photograph description of person being photographed or filmed (to be filled out on day photograph or video is taken) male/female: name hair...
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Interview release form to be signed by interviewees or other individuals who may appear in a young citizens video. interviewer / student name school project name regional heritage fair i hereby grant consent on my own behalf and/or on behalf of my...
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Department of health and human services centers for medicare & medicaid services 7500 security boulevard baltimore, maryland 21244model, interview and property release form (please print) i, , hereby give permission to the centers for medicare &...
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Publication/website/photo/video/interview release and authorization i, (print name) residing at (address) understand that the community service society of new york (css) promotes its work through publications, the media, and appeals for support,...
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Photo / video / web release form dear parent or guardian, on occasion, representatives from and/or employees of the tacoma public schools may wish to photograph, videotape and/or interview individuals in connection with school programs, projects or
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Photo/video/website release formdear parent/guardian:on occasion, representatives from the media or the northwest indiana symphony orchestra wish to photograph,videotape, and/or interview children in connection with northwest indiana symphony...
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Carls center for clinical care and education 1101 health professions building mount pleasant, mi 48859 phone: (989) 7743904 fax: (989) 7741891 .carlscenter.cmich.edu audiology clinics speechlanguage pathology clinics physical therapy clinics...
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Photo / video / artwork release formdear parent / guardian,on occasion, representatives from the media, burbank unified school district, or the vma,wish to use student photos, videotape, artwork, and / or interview students in connection...
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Photo and interview release form date i hereby grant the the center for developmental disabilities advocacy and community supports (the center) permission to interview me and/or to use my likeness in photograph(s)/video in any and all of its...
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Western nevada community college authorization to be interviewed/photographed date: i (name) hereby give my permission to be photographed and/or interviewed . i authorize this interview/photograph to be used in newspaper article television/video...
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Liability and photographic releasein consideration of agua fria union high school district agreeing to photograph orinterview me and in consideration of the use of the facilities and services provided to meby the agua fria union high school...
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Release form for pr, print and video testimonialsi hereby give georgia transplant foundation, inc and those acting pursuantto its authority, permission to publish my testimonial interview, video and photograph.i hereby authorize georgia transplant...
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Ucps photo, video and news interview release formi do hereby grant to union county public schools the unlimited right to use and/or reproduce photographs,likenesses or the voice of my child in any legal manner and for the internal or external...
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