I hereby give [Trout Unlimited Chapter _____________] the right to use photographs taken of me this date for publishing, illustration, advertising, trade and promotion, or any other use in any medium for any purpose.
I release Trout Unlimited from any claims and demands arising out of the use of the photographs. This release also covers legal representatives and any licensees of these photographs. I understand that photographs will be copyrighted in the name of Trout Unlimited and may be used in conjunction with other photographs, as part of a composite, or in any form whatsoever.
I am 18 years old or older. ___ Yes ___ No
Model name (please print): ____________________________
Signature of Model: _________________________________
Address: ________________________
Address: ________________________
Witness (please print): ___________________________
Signature of Witness: ____________________________
Date:_____________
* * * * * * * * *
If the model is under 18 years of age, consent should be given by parent or guardian as follows:
I hereby certify that I am the parent or guardian of (please print model name)___________________.
For the model named above, and for value received, I do give my consent without reservations to the foregoing on behalf of him or her or them.
Signature of Parent or Guardian: __________________________ Date:__________________
Witness (please print): ___________________________
Signature of Witness: ____________________________
Please return this completed form to: (enter your chapter information here)