Photo Release Form

I hereby give [Trout Unlimited Chapter _____________] the right to use photographs taken of me this date for publishing, illustration, advertising, trade and promotion, or any other use in any medium for any purpose.

I release Trout Unlimited from any claims and demands arising out of the use of the photographs. This release also covers legal representatives and any licensees of these photographs. I understand that photographs will be copyrighted in the name of Trout Unlimited and may be used in conjunction with other photographs, as part of a composite, or in any form whatsoever.

I am 18 years old or older. ___ Yes ___ No

Model name (please print): ____________________________

Signature of Model: _________________________________

Address:  ________________________

Address:  ________________________

Witness (please print): ___________________________

Signature of Witness: ____________________________


* * * * * * * * *

If the model is under 18 years of age, consent should be given by parent or guardian as follows:

I hereby certify that I am the parent or guardian of (please print model name)___________________.

For the model named above, and for value received, I do give my consent without reservations to the foregoing on behalf of him or her or them.

Signature of Parent or Guardian: __________________________ Date:__________________

Witness (please print): ___________________________

Signature of Witness: ____________________________

Please return this completed form to: (enter your chapter information here)