ࡱ> 796 bjbj! ! .CfCf XXXXXlll8l))))))))$,.B)XB)XXW) LXX) ) '|h(0~')m)0)(Za/a/$h(a/Xh( B)B)~B)a/ :  (PLEASE NOTE: THIS IS A SAMPLE MEDIA RELEASE FORM CREATED FOR THE AMERICAN LIBRARY ASSOCIATION AND MAY REQUIRE REVISION FOR YOUR ORGANIZATIONS NEEDS. PLEASE ENSURE THAT YOU ARE COMPLYING WITH ALL PRIVACY OBLIGATIONS OF YOUR LIBRARY AND THE FACILITY YOU ARE PARTNERING WITH, AS WELL AS THE WISHES OF YOUR PROGRAM PARTICIPANTS.) Photo Release Agreement I hereby consent to the use of my name, photograph, and/or likeness by (INSERT LIBRARY NAME AND PARTNER ORGANIZATION NAME) (Owners) for any purpose and in any manner, including the purposes of advertising and/or trade in any and all media, including the Internet, throughout the world, without restriction as to frequency or duration of usage. The Owners shall be the absolute owners of any materials (and all rights therein, including the copyright) produced pursuant to this agreement. I understand and accept that I will not receive any monetary compensation for any photographs, material, or likenesses, or their use, neither now nor at a later date. I hereby release the Owners and any third parties involved in the creation, publication or use from liability for any claims by me or any third party in connection with use of the photographs, name and likeness. I hereby warrant and represent that I am at least 18 years of age*, and have the full right to contract in my own name with respect to the matters stated above.  Name (print) Signature Date Street Address City State Zip * Complete if individual is under 18: I, the undersigned, warrant and represent that I am the parent or legal guardian of , whose signature appears above. I have read the above release agreement and am fully familiar with the contents thereof, and I hereby grant my permission and consent to all of the contents above. Name (print) of parent or legal guardian Signature Date Street Address City State Zip  ADVANCE \y 736 CHDS01 MAV 979443v1     `zI J K M f  p r s t u CEøwwwwrwwww h)5jh)UmHnHuh)hCJaJh)CJaJhCJaJhW)h)5CJaJhW)hW)5CJaJh)h)CJaJh)hkOJQJ^JheOJQJ^JhW)he5 hFj5 hW)5hW)hW)5 hW)hehe,J K L M e f p q r t ^gd) $^a$gd)  !^gdkgdW) }@ABCgdo  !^gdk^gd)h)h6jh6UhohkCJhohCJjhohCJUhOJQJ^Jgdo   ^,&P/ =!"#$% ^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH 8`8 Normal_HmH sH tH 8@8  Heading 1$@&CJB@B  Heading 2$$@&a$5CJZ@Z  Heading 3$$ f)*$@&a$5@CJ8OJQJDA D Default Paragraph FontViV  Table Normal :V 44 la (k (No List VOV Return Addressd8  @ CJOJQJJOJ Return Address Dark5@:O: OfficeFrom$a$CJ0"0 WhoFrom$a$0U`10 Hyperlink>*B*TP@BT Body Text 2$ 0*$a$@CJOJQJHB@RH Body Text$ 0*$a$@CJ4@b4 Header  !4 r4 Footer  !J^@J Normal (Web)dd[$\$CJaJLC@L Body Text Indent ^CJaJPR@P Body Text Indent 2 ^CJaJ*W`* Strong5\H@H  Balloon TextCJOJQJ^JaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK]     T@   @H 0(   (  \B  C D#" ?\B  C D#" ?\B  C D#" ?\B  C D#" ?\B  C D#" ?\B  C D#" ?\B  C D#" ?\B   C D#" ?VB   C D"?B S  ?rtCD'tt't't k&t'tt't 'tIJJMMRRBBDEPPyIJJMMRRBBDEPPy?H EH  FaIhs81^ Xp L AuѮ^ hh^h`OJQJo( hh^h`OJQJo(h ^`OJQJo(oh ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(hh^h`)hh^h`)h^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHXp?Hs81^XpL Au FaI                  "!s]LQWhW)6&]HryiAyetwo|AFjt 7AoiM[k*-Fa./d]ld?c_)@@Unknown G*Ax Times New Roman5Symbol3. *Cx ArialE"Univers (PCL6)5Univ45Y CG TimesTimes New Roman5. .[`)Tahoma?= *Cx Courier New;WingdingsA$BCambria Math"h::9++!24 3QHP?k2! xx American Library Association Judy Crowley Sarah Ostman$      Oh+'0p   , 8 DPX`h ƵJudy Crowley Normal.dotmSarah Ostman2Microsoft Office Word@F#@@cu@cu+՜.+,0  hp   Ƶ Ƶ Title  !"#$%'()*+,-/0123458Root Entry F~:1Table/WordDocument.SummaryInformation(&DocumentSummaryInformation8.CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q