Media Confidentiality Acknowledgement Form
Please complete this form to acknowledge your understanding and acceptance of media confidentiality requirements.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Organization or Affiliation
*
Role or Title
*
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Type of Media Access
*
Please Select
Press
Photography
Video
Audio
Other
Project or Event Name
*
Date of Acknowledgement
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Confidentiality Statement
*
I acknowledge and agree to maintain the confidentiality of all media materials and information as outlined above.
*
I agree
Signature
*
Submit Acknowledgement
Submit Acknowledgement
Should be Empty: