PHOTO/VIDEO CONSENT FORM


1. Permission to photograph or record

I, permit AIDS Healthcare Foundation (“AHF”) to:

at

on .

I agree that AHF may keep the photographs or recordings above (individually or together, the “Media”) indefinitely.

2. Authorization to use/disclose

I further authorize AHF to use and/or disclose the Media in media galleries, websites, printed materials, online, social media, business operations, publicity, advocacy, marketing, advertising, or fundraising.

I understand that I may revoke this document at any time by sending a written notification to AHF at:

AHF Marketing
6660 Santa Monica Blvd, Floor 2
Los Angeles, CA 90048

However, I also understand that my revocation will not affect any actions that AHF takes with the Media before the receipt of the written revocation.

Leave this empty:

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Signature Certificate
Document name: PHOTO/VIDEO CONSENT FORM
lock iconUnique Document ID: 8afcd74ec1ad1972f4446a9627650abb9fb56587
Timestamp Audit
August 7, 2018 12:37 pm PDTPHOTO/VIDEO CONSENT FORM Uploaded by Kevin Pakdivichit - [email protected] IP 12.208.247.130