MEDIA RELEASE

You must be 18 years of age or older to sign this release form. If under 18 please have your Parent/Guardian fill this form out.

I hereby consent to release, for possible publication, my name and/or photo(s) and/or video(s) taken by myself or any authorized Great Falls Area Chamber of Commerce (GFCC) representative for news and/or publicity purposes. This may include television, newspaper, magazine articles, social media websites, and or GFCC publications (newsletters, flyers, brochures, web pages, etcetera) I also agree to allow the publication or broadcast of my name in connection with any photos and or videos taken by myself or by GFCC, and I understand that I will not receive remuneration/payment for my voluntary participation or future use of any photos and/or videos of me. I understand that photos and/or videos for the media and/or World Wide Web may be used in publications and or websites outside of GFCC’s control.
This consent remains in effect indefinitely unless notice of revocation of authorization by consenter is submitted in writing to GFCC. For more information please contact (406)761-4434.

By typing below this becomes your “digital signature” and is a binding agreement with GFCC.

Name(Required)

Phone(Required)

Birth Month/Year(Required)

Parent/Guardian Name (if applicable)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Date(Required)