Media release form - International Association for Hospice & Palliative Care

First name

Last Name

Email address

Repeat email address

City and country where you live

Today's date

Photo/image

Format accepted: JPG or PNG. Maximum file size: 10MB

To submit other type of photo/image, please contact the IAHPC Team.

This photo is a submission for the IAHPC Photo Contest.

As the owner of the copyright of the photo/image described below, I hereby grant and authorize the International Association for Hospice and Palliative Care, Inc. (“IAHPC”), a Texas nonprofit corporation the right to use any photo and/or image in any lawful organizational materials, including, but not limited to, newsletters, announcements, flyers, posters, brochures, fundraising letters, annual reports, press releases, websites, social networking sites and other print and digital communications, without payment or any other compensation. This authorization extends to all languages, media, formats and markets now known or later discovered.

Whenever provided in physical format, I understand and agree that these materials shall become the property of the IAHPC and will not be returned.

Description of the photo/image

This authorization shall continue indefinitely, and I may revoke it at any time by submitting a notice in writing to the IAHPC.

I hereby hold harmless and release the IAHPC from all liability, petitions, and causes of action which I, my heirs, representative, executors, administrators, or any other persons may make while acting on my behalf or on behalf of my estate.

I confirm that I have read the above authorization, release, and agreement, prior to its execution, and confirm that I am fully familiar with its contents.
I confirm that I have received written consent from the individuals to have their picture/video taken. (Download consent form, print it and once completed, keep it in your files)