Please read the following carefully, by submitting this form you are agreeing to the following:

I understand that the photograph(s) or video or audio recording(s) taken of me by agents, employees or representatives of The Regents of the University of California (hereinafter “University”) shall be used in connection with the University's dissemination of information on its public service and academic programs to the general public.

I hereby irrevocably authorize the University to copy, exhibit, publish or distribute any and all such images and audio of me or wherein I appear, including composite or artistic forms and media, for purposes of publicizing University programs or for any other lawful purpose. In addition, I waive any right to inspect or approve the finished product, including written copy, wherein my likeness appears.

I hereby hold harmless and release and forever discharge the University from all claims, demands and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

If you would like to view a PDF version of this form, please click here: https://drive.google.com/file/d/1uartOqfOwhyENYF1tkW9EaYFHiXOUsqu/view?usp=sharing