Model Release Form

MANSFIELD BARN PHOTOGRAPHY CONTEST — MODEL RELEASE FORM
Please print form, complete all sections, and enclose with your photo contest submission.

I hereby give the photographer (listed below), the Mansfield Historical Society, and the Town of Mansfield Agriculture Committee, the absolute right and permission to use my image and/or the image(s) of (a) minor child(ren) in my family, in their promotional materials and publicity efforts without payment or any other consideration. All images become the property of the Mansfield Historical Society, though I retain the copyright.

I understand that the photograph(s) 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 photographer, the Mansfield Historical Society, and the Town of Mansfield Agriculture Committee, their officers, employees, agents, and designees from liability for any violation of personal or proprietary rights I may have in connection with such use. I certify that I am 18 years of age or older.

Name(s) of
individual(s)
in photo:

Photographer's name:

Your full name:

Mailing address:

City & state: Zip code:

Phone number: E-mail:

Your signature: Date:

cut here for multiple entries

MANSFIELD BARN PHOTOGRAPHY CONTEST — MODEL RELEASE FORM
Please print form, complete all sections, and enclose with your photo contest submission.


I hereby give the photographer (listed below), the Mansfield Historical Society, and the Town of Mansfield Agriculture Committee, the absolute right and permission to use my image and/or the image(s) of (a) minor child(ren) in my family, in their promotional materials and publicity efforts without payment or any other consideration. All images become the property of the Mansfield Historical Society, though I retain the copyright. I understand that the photograph(s) 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 photographer, the Mansfield Historical Society, and the Town of Mansfield Agriculture Committee, their officers, employees, agents, and designees from liability for any violation of personal or proprietary rights I may have in connection with such use. I certify that I am 18 years of age or older.
Name(s) of individual(s) in photo:
Name(s) of individual(s) in photo:
Photographer's name:
Your full name:
Mailing address:
City & state:		Zip code:
Phone number:		E-mail:
Your signature:		Date: