Cherry Capital Paddle America Club Media Release Form

Cherry Capital Paddle America Club
PO Box 803
Traverse City, MI 49685-0803

If you have already completed this form and turned it into CCPAC, there is no need to do it a second time unless you have changed your preference.

Please complete this form by checking the appropriate box below indicating whether you allow or refuse CCPAC and its representatives the right to use your likeness in CCPAC publications and promotions. Select the appropriate check boxes below, type in the information where requested (fields for typing are provided), print the form, sign where requested, and send to CCPAC.

Permission to Use Photograph [Video/Audio]

I grant to Cherry Capital Paddle America Club (CCPAC) and its representatives the right to take photographs [video/audio] of me and my property in connection with CCPAC events, and I authorize CCPAC and its representatives to copyright, use, and publish the same in CCPAC print and/or electronic publications. I agree that CCPAC may use such photographs [video/audio] of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising and Web content. I forever release and discharge CCPAC from any and all claims, actions, and demands arising out of or in connection with the use of said materials, including, without limitation, any and all claims for invasion of privacy, publicity, and libel or slander.
 

Refusal to Allow Use of Photograph [Video/Audio]

I do not grant to CCPAC and its representatives the right to use photographs [video/audio] of me and my property in connection with CCPAC events for use in print and/or electronic publications.

I have read and understand the above:

Signature: _______________________________________

Printed name:

Address:

Date (mm/dd/yy):

Signature, parent or guardian: _______________________________________
(if under age 18)

Please type in the open fields, print the form, sign it, and send it to CCPAC,
or bring it to a CCPAC event and give it to a CCPAC representative.