MODEL RELEASE
I, ________________________________________, the undersigned, do hereby grant
Michigan Technological University or anyone Michigan Tech may designate, full
permission to use and reproduce or for any legal purpose, any and all photographs and
recordings taken by Michigan Tech, in which my image or voice may appear. I hereby
waive any and all claims to said photographs or recordings and to compensation for their
use. This release is executed gratuitously and/or for any self-satisfaction which I may
derive from any publication or programs in which my photograph or voice will appear.
Event and location of photo
Date
Name
(Please print)
Signature
(Model or agent)
Signature of guardian
(If under 18 years of age)
Email
Telephone
Michigan Technological University
University Marketing and Communications
1400 Townsend Dr.
Houghton, MI 49931-1295
(906) 487-2360