The Center for Community Media at Governors State University presents a Conversation on Democracy, Inclusion, and the Media

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Event Address: Governors State University, Room F1622
Contact us at communitymedia@govst.edu

How will you attend? *

I'll be there in person

I'm interested in a virtual option

What is your name? *

What is your primary affiliation with GSU? *

Student

Faculty

Staff/Administration/Leadership

Community Member

What is your email address?

Media Release Acknowledgement I HEREBY CONSENT TO THE USE, PUBLICATION, BROADCAST, TELECAST, DISTRIBUTION AND CIRCULATION OF MY NAME, PHOTOGRAPH, IMAGE, AND/OR LIKENESS BY Governors State University (GSU) in any GSU sponsored product and/or publication used for recruiting, promotional, advertising, or commercial purposes, and shall include, but not is limited to, the GSU Website, newsletters, catalogs, trimester schedules, handbooks, and brochures. I further understand and agree that this photo release consent shall remain in full force and effect until canceled in writing and in a reasonable advance of any said publication. I HAVE READ THE FOREGOING MEDIA RELEASE CONSENT. I FULLY UNDERSTAND ITS CONTENT AND AM VOLUNTARILY AGREEING TO THIS MEDIA RELEASE CONSENT AS A FREE AND VOLUNTARY ACT AND UNDERSTAND BY REGISTERING FOR THIS EVENT, I AM GIVING FULL CONSENT.

Yes, I agree to the Media Release form as written above.

Required

How did you hear about this event?

Website

Friend

Newsletter

Other:

Clear selection

Comments and/or questions. If you require an accommodation to attend this event, please indicate that here at least 3 days prior to the event.

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms