Photo / Video Release Form

The Maine Mathematics and Science Alliance (MMSA) is a non-profit educational organization that provides teaching and learning resources in science, technology, engineering and math. Our work often involves showing educators and students in action, workingon STEM projects that we sponsor. We ask for your consent to share any and all photographs, written feedback, audiorecordings and video recordings taken of you by MMSA to be used in and/or for promotional materials including but not limited to; newsletters, flyers, posters, brochures, advertisements, fundraising letters, annual reports, press kits and submissions to journalists, websites, social networking sites and other print and digital communications.I grant permission to the Maine Mathematics and Science Alliance, its employees and anyone authorized by them, the irrevocable and unrestricted right to use and reproduce, in print or electronic format, the photos, videos, audio recordings, quotes, or written text taken of me.

I hereby grant permission for MMSA and its employees and authorized agents to produce, reproduce, edit, print, or share photographs, written feedback, audio recordings and video recordings of me.I release MMSA and MMSA assignees, licensees, and successors from any claims that may arise regarding the use of my image, including any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity, or copyright.

I understand that this release means the photos and videos may be accessible to the public, and thus may be used in ways that MMSA cannot anticipate.

I understand I will not now or at any point in the future receive payment or consideration for the use of my image including if said image is used in advertising or commercial purposes.

I affirm that I am at least 18 years old, and I accept the agreement as described above.

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207.626.3230
Physical Address: 343 Water Street, Augusta, Maine 04330
Mailing Address: PO Box 2246, Augusta, Maine 04338