Photo Release Form

I hereby give [Company Name] consent to record, videotape and photograph my image and/or voice to be used in the following ways (check all that apply):

• Company intranet accessible by employees only.
• Company website accessible to the public.
• Employee newsletter.
• Client/customer newsletter.
• Printed annual report.
• Other __________________________________________

I understand that no special compensation will be provided to me for use of my image and that I may not be informed in advance of the specific use of my image.


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Employee name (please print)

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Employee signature                                                               Date