Debutante's Photo and Video Release Form 2021
Alpha Kappa Alpha Sorority, Incorporated                                    
Delta Omega Omega Chapter                                                        
P. O. Box 2105                                                                                    
Pine Bluff, AR 71613
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RELEASE OF PHOTOGRAPHY AND VIDEO
I hereby give permission for photographs/video to be taken for the purposes of public information and publicity.  I understand that these images/videos may appear in Alpha Kappa Alpha Sorority, Incorporated, Delta Omega Omega Chapter's reports, newsletters, brochures, and other publications as well as websites, social media, and other online communications.  

I further understand that I am releasing any interest in these images/videos.

Debutante's First Name *
Debutante's Last Name *
Debutante's Signature *
By providing your initials you are submitting your electronic signature.
Participant's Parent/Guardian's Signature
(If Debutante is under 18) By providing your initials you are submitting your electronic signature.
Date *
MM
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DD
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YYYY
THIS FORM MUST BE SUBMITTED NO LATER THAN NOVEMBER 5, 2021
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