UCSC Photo/Video Release Form

I, (please print your name) _______________________________________________ , give the University of California, Santa Cruz, the absolute right and permission to use a photograph(s) and or video(s) of me in it's promotional materials and publicity efforts. I understand that the photographs may be used in a publication, print ad, direct-mail piece, electronic media (e.g. video, CD-ROM, Internet/WWW), or other form of promotion. I release the University, the photographer, their offices, employees, agents, and designees from liability for any violation of any personal or proprietary right I may have in connection with such use. I am 18 years of age or older.

Signature __________________________________________________________

Address ___________________________________________________________

City ____________________________________ State _______ Zip __________

Phone (_______) _____________________________ Date __________________

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