Appendix K: Image Release

IMAGE RELEASE FORM

I, (please print) _________________________________________________, give Moberly Area Community College the absolute right and permission to use my image(s) whether photo or recorded, in its promotional materials and publicity efforts. I understand that the image(s) may be used in a publication, print advertisement, direct-mail piece, digital media (e.g. video, CD-ROM, Internet, World Wide Web), or other form of promotion. I release the College, the photographer, their offices, employees, agents, and designees from liability for any violation of my personal or proprietary right I may have in connection with such use.

Student Printed Name: __________________________________________

Signature: ____________________________________________________

Student ID: ___________________________________________________

Email: _______________________________________________________

Address: _____________________________________________________

City: __________________________ State: _____ Zip Code: ___________

Phone: (___)______________________ Date: _______________________

___ Obscure personal identifying characteristics when possible.