PROMOTIONAL RELEASE
for students
name ________________________________________________
primary phone number ________________________________
secondary phone number _____________________________
city where you live ____________________________________
program of study _____________________________________
campus where you will attend classes _________________
for office use only:
traditional student
adult student
notes:
I hereby release Roane State Community College from any claim relative to the publishing
of any photograph and/or promotional or news copy in which I am a participant. This applies to commercial advertising, news coverage, promotions or public service on TV radio,
video, Web site or in newspapers, magazines or other such recruiting and promotional
print pieces.
_______________________________________________________ Date ______________
Signature