Free model release form 35
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Photograph and Publicity Release Form - Sample
I, ________________________, give the AmeriCorps Nonviolence KOPS Program and its
fiscal agent, the Michigan Institute for Nonviolence Education (MINE), permission to use
my name, likeness, image, voice, and/or appearance as such may be embodied in any
pictures, photos, video recordings, audiotapes, digital images, and the like, taken or made
on behalf of the KOPS Program or MINE activities. I agree that the KOPS Program and
MINE have complete ownership of such pictures, etc., including the entire copyright, and
may use them for any purpose consistent with the KOPS/MINE’s missions. These uses
include, but are not limited to illustrations, bulletins, exhibitions, videotapes, reprints,
reproductions, publications, advertisements, and any promotional or educational materials
in any medium now known or later developed, including the Internet. I acknowledge that I
will not receive any compensation, etc for the use of such pictures, etc., and he