Promotional Event Recording Release
Please complete this form to provide your consent for recording and promotional use at the event.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Event Name
*
Event Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Event Location
*
Role or Relationship to Event
*
Please Select
Participant
Speaker
Performer
Organizer
Volunteer
Other
Recording Description (e.g., type of recording, purpose)
*
Release Permission
*
I grant permission for my image, voice, and likeness to be recorded and used for promotional purposes by the event organizers.
I do NOT grant permission.
Signature
*
Submit Release
Submit Release
Should be Empty: