Harding County History Sumission
Please use this form to submit digital photopraphs to the Harding County Centennial Committee History projet.
Full Name
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First Name
Last Name
Phone Number
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Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
example@example.com
Number of photos submitted:
*
Description of photos (inlcude as much detail as you like):
*
File Upload
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of
I hereby grant Harding County Centennial Committee (releasee) permission to use submitted photographs in the Harding County History digital display. I hereby affirm that such release to the releasee does not constitute any form of compensation, including royalties arising from the photographs, to my benefit. I understand and agree that the DIGITAL PHOTOGRAPHS in the possession of the releasee shall be used the Harding County History digital display. I hereby hold harmless, release, and forever discharge the from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I declare true my age of consent, and in case I am under the age of such consenting age, I have obtained the required consent from my parents/guardians as evidenced by the signatures below:
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I am of legal age
I am a minor and represented by my parent/guardian
Signature of parent/guradian
Type name of parent/guardian
Questions
If you are having trouble uploading images, please contact Courtney Mithell at courtneymitchell@protonmail.com
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