Political Event Media Release Consent Form
Complete this form to grant or decline permission for event photography, video, audio recording, and related media use at a political event.
Attendee Information
Attendee Full Name
*
First Name
Middle Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Event and Release Details
Event name or location
*
Event date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Media release consent
*
I agree
I do not agree
Guardian or Authorized Representative
Guardian or Authorized Representative Name
*
First Name
Last Name
Relationship to Attendee
*
Submit
Should be Empty: