PHOTO/VIDEO RELEASE FORM

I CONSENT TO AND AUTHORIZE the use and reproduction,

in print or electronic format by the University of Michigan

(U-M), or anyone authorized by U-M, of any and all photographs

or video which have been taken on this day for any publicity,

without compensation.

I UNDERSTAND that all images—electronic, print, and

recordings—are owned by U-M which may publish or use them in any professional

manner, including, but not limited to: print publications, websites, podcasts, and

Subject/Model

Address

Email

(if under 18, provide parent/guardian email + address)

Name (printed)

Signature