JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
IJ Media Release Form
For questions about this form, please contact people@impactjustice.org or comms@impactjustice.org
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Today's date
*
MM
/
DD
/
YYYY
I hereby give Impact Justice consent to record, videotape, and photograph my image and/or voice to be used in the following ways (check all that apply):
*
Impact Justice publications and external communications
Impact Justice website
Impact Justice social media
Internal newsletters and communications
Impact Justice staff profile (on the website)
None of the above
Other:
Required
Signer's full name
*
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Impact Justice.
Report Abuse
Forms
