ian sapelli

Photo/Video Release Form

AUTHORIZATION TO USE PHOTOGRAPHS AND/OR AUDIO-VISUAL

I, hereby authorize (photographer/videographer), Public Xcess (Corporation), PX, or (project or project sponsor) to use, reproduce, and/or publish photographs and/or video that may pertain to me— including my image, likeness and/or voice without compensation. I understand that this material may be used in various publications, broadcast media, cable, digital media, social media, public affairs releases, recruitment materials, broadcast public service advertising (PSAs) or for other related endeavors.

This material may also appear on the Corporation's or project sponsor's Internet Web Page and social media pages. This authorization is continuous and may only be withdrawn by my specific rescission of this authorization. Consequently, the Corporation or project sponsor may publish materials, use my name, photograph, and/or make reference to me in any manner that the Corporation or project sponsor deems appropriate.

Description of Material (Photos/Audio-Visual):

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__________________________________________ Signature

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