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MEDIA AUTHORIZATION
I, ____________________________________, hereby authorize
the Foreign Service Youth Foundation, its
(Name of Individual)
facilities, subsidiaries and affiliates, and their employees
and authorized agents and representatives (hereafter, collectively
"FSYF") to photograph, videotape, film, and/or record
me, and I consent to the use of such photographs, videotape,
film, or recording (hereafter, collectively "materials")
by the FSYF in any publication, program, presentation or other
media, now or in the future, without compensation to me for
the purposes of education, public relations, marketing, program
development, fund-raising, or news media use.
I understand and agree that such materials, including all
negatives, positives, prints, tapes, and reproductions shall
become and remain the sole property of the FSYF, and I shall
have no right, title, or interest in such items.
I further understand and agree that these materials may be
kept on file by the FSYF for potential future uses, and I
agree to such future uses, consistent with the purposes indicated
on this form.
I further agree to release the FSYF from any and all liability
arising from or in connection with the taking, use, publication
or dissemination of such materials.
Foreign Service Youth Foundation
________________________ _______________________
Signature of Individual Date
__________________________ __________________________
Parent/Guardian (please print) Signature of Parent/Guardian
______________________________________________________________
Address
*Note: if the individual is a minor, the individual's parent
or guardian must sign this form
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