Photo Image Release - Lincoln University
-377190-57277000Photo Image Release-2067342068430I authorize Lincoln University to record and photograph my image and/or voice, or that of my child, for use by Lincoln University or its assignees in research, educational, and promotional programs.I understand and agree that these audio, video, film and/or print images may be edited, duplicated, distributed, reproduced, broadcast and/or reformatted in any form and manner without payment of fees in perpetuity. Subject’s name (adult or youth) ________________________________689306155575If subject is a minor, the signature must be of parent or guardian 00If subject is a minor, the signature must be of parent or guardian Signature ______________________________ Date _____________1101725186690Needed only if the subject is a minor. 00Needed only if the subject is a minor. Printed Name ______________________________ Date _____________53663854141498Last updated SAVEDATE \@ "M/d/yy" \* MERGEFORMAT 6/20/1800Last updated SAVEDATE \@ "M/d/yy" \* MERGEFORMAT 6/20/18 ................
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