Media Release Form

"*" indicates required fields

I. Use of Your Name

The Ministry takes your privacy very seriously. I give the Motherless Daughters Ministry permission to identify me either by first name, by initials, or by a pseudo-name.*

1. Can the ministry use your full name?

2. Can the Ministry identify you by first name only?

3. Do you prefer the use of your initials only?

4. Do you prefer the use of a pseudo-name?

Please write below in the space available your first name, initials, or pseudo-name for use by the Ministry.*

Declination for Use of Name

I decline the use of my name (first and last name, initials, or pseudo-name) in any fashion by the Motherless Daughters Ministry.

Signature*

The parties agree that by typing first and last name, this form may be electronically signed.

II. Permission to Use Release Form

The Motherless Daughters Ministry, Inc. is growing and always trying to reach more women in need. Therefore public relations and awareness of the Motherless Daughters Ministry are key areas. I understand that photographs, audio, video, or media clips may appear in the following:

Web sites
Motherless Daughters Newsletter
Brochures
Presentations
Blog
Other displays for the purpose of promotion and awareness of this ministry

I grant the Motherless Daughters Ministry, Inc. permission to use my name, likeness, image, voice, remarks, and/or appearance as embodied in any photographs, video recordings, audio recordings, media clips, digital images, illustrations, etc. taken or made on behalf of Motherless Daughters Ministry, Inc. for educational and promotional purposes, for the production of resources and programs, and any commercial distribution of the resulting education or promotional products and resources.

I agree that the Motherless Daughters Ministry has full ownership of any such media, including the entire copyright, and may use the media for any purpose consistent with Motherless Daughters Ministry, Inc. These uses include, but are not limited to, printed materials, electronic materials, Internet postings, advertisements, and all other educational or promotional material in any medium.

Initial*

I acknowledge that I will not receive any compensation for the use of such media and unless otherwise agreed in writing, any claim for remuneration, residuals, royalties or other payment in respect to usage by the Motherless Daughters Ministry, Inc. is waived.

Initial*

I understand the Motherless Daughters Ministry, Inc. is not obliged to make use of the material.

Initial*

I confirm that I fully understand that Motherless Daughters Ministry, Inc. can rely upon this permission until I give written notice of its revocation.

Initial*

I hereby release Motherless Daughters Ministry, Inc. from any and all claims that arise out of or are in any way connected with such use made by me out of any loss, damage, accident, or injury as a result of the photography, audio, or video to which this permission relates.

Signature*

The parties agree that by typing first and last name, this form may be electronically signed.

Witness*

The parties agree that by typing first and last name, this form may be electronically signed.

Declination of Permission for Use

I decline to allow the use of any photographs, audio, video, and media clips.

Signature*

The parties agree that by typing first and last name, this form may be electronically signed.

This field is for validation purposes and should be left unchanged.