Publicity Release Form
I allow _____________ _______________ to participate in the Ace
Print First Name
Print Last Name
Writers contest, an educational event sponsored by the University of
Louisiana at Monroe (ULM) and the ULM College of Education and
Human Development.
1. I agree to allow ULM to copy, modify, and distribute online the
creative writing work and voice narration of this individual, without
compensation or restriction.
2. I agree to allow ULM to use, copy, modify, and distribute photos,
audio, and video of this individual for public relations purposes in any
distribution channel, without compensation or restriction.
3. I agree to allow ULM to authorize designated professional
personnel from the media to take, modify, and distribute photos,
audio, and video of this individual for public distribution in newspapers,
TV, the Internet, and any other distribution channels, without
compensation or restriction.
_______________ _____________
Your Printed Name
___________________
Your Signed Name
____________________________________
Your legal relationship to this individual
_______
Date
Instructions
Please sign and return to your teacher. Every winner must have
this form signed by a parent or guardian.
Publicity Release Form, University of Louisiana at Monroe, Ace Adventures