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Department of Theatre and Film

Publicity Release Form

Department of Theatre and Film
Student Publicity Information

Please do not abbreviate. Completion of this form gives the Department of Theatre & Film permission to release the information to the news media. If you do not want certain information released to the media, please note that so we are aware of your intentions.

Production Title:
Role:		Character/Crew Position:

Full Name as you want it to appear in the program:

Local Phone:

Email (full pathname required):

Permanent (Home) Address:

HomeTown:

State:

County:

High School Attended:

Year Graduated:

Class Rank at BGSU
- Please choose from pull down menu:

Major:

Grant-in-Aid/Scholarship?

Member of :

BGSU can use photos and other representations of me from this production in accordance with the Photograph and Article Release and Consent Form as printed below.

Photograph and Article Release and Consent Form: For and in consideration of my involvement in the above mentioned Bowling Green State University Department of Theatre and Film production (the "Project"), I hereby give my consent to Bowling Green State University ("University") to copyright, reproduce, publish or otherwise use my photograph or likeness in the Project and/or in any other printed or recorded materials (including, but not limited to, materials recorded in any electronic format) that may be distributed or generated by or for the University, related to such Project. I also give the University the right to copyright, reproduce, and publish in the Project, or in such materials, an article that contains a reference to me, or a quote by me, and/or a summary of my interview with a University representative.I waive any right I may have to inspect or approve the finished photograph, likeness, or text that may be used in the Project or the above described materials.I represent that I am over 18 years of age and that I am giving this consent and waiver of my own free will and without the promise of compensation or other consideration. THIS IS A RELEASE OF LEGAL RIGHTS. READ AND BE CERTAIN YOU UNDERSTAND IT BEFORE CHECKING THE "I AGREE" BOX.

Special Requests or Notes:

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