Public Exposure Agreement Form
Document permission for the specified public use of selected content.
Full name
*
First Name
Last Name
Email
*
example@example.com
Organization or affiliation
Content types covered
*
Photo
Video
Audio or voice
Name
Statements or quotes
Intended publication channels
*
Organization website
Social media
Print materials
Digital publications or newsletters
Presentations or events
Description of intended use
*
Limitations or restrictions
I consent to the public use of only the content types and publication channels selected above, for the intended use described in this form. Any limitations or restrictions I have provided apply to this permission.
*
I agree
Signature
*
Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: