College of Business Media Release Form : University of Louisville

Acknowledgement*

I grant permission to the University of Louisville College of Business, hereinafter known as the “Media” to use my image and words (written, audio, photographs, and/or video) for use in Media publications including.

Types of Media/Publications*

Please check all that apply

Waive Review*

I hereby waive any right to inspect or approve the finished electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image.

Legal Status*

Please check the paragraph below which is applicable to your present situation:

I am 18 years of age or older and I am competent to contract in my own name. I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.
I am the parent or legal guardian of the below named child. I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.

Electronic Signature*

Please type your name as your electronic signature

Date*

Name*

First Last

Email*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Electronic Signature of Parent or Guardian

(if under 18 years of age)

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College of Business Media Release Form

COB Media Release Form