SAMPLE PHOTO SUBMISSION/PERMISSION WAIVER
[pic]
INTERNATIONAL ALLIANCE OF ALS/MND ASSOCIATIONS
MARCH OF FACES
We invite you to help promote ALS/MND AWARENESS by participating in the International Alliance’s March of Faces Banner!
ABOUT THE BANNER
The ALS/MND March of Faces Banner is a pictorial display of the courageous women and men, both past and present stricken with the fatal neuromuscular disease, amyotrophic lateral sclerosis, also known as Lou Gehrig's disease or motor neuron disease. PALS (person with ALS/MND) Kyle Hahn conceived the Banner in July 1997, as an advocacy and awareness tool.
1. The Photograph
Email a .jpg or .png version of a photo and attach this form to your message. Send all March of Faces submissions to the General Manager at alliance@als-.
Photos are resized to fit a portrait for banner imprint; landscape orientation photos will incur cropping.
You are welcome to include family or caregivers in the picture if you wish.
Photos in memoriam are accepted.
• Please note that all submissions from member associations to be displayed at the Annual Alliance Meeting must be received by 1 November.
2. The Submission Form Please include the following information with your submission:
FOR THE BANNER Include contact’s information if applicable:
PALS Name Contact Name
PALS Date of Birth Contact Email Address
PALS Diagnosis Date Contact Telephone
FOR OFFICE USE
PALS City State/Province
PALS Country
PALS E-mail
PALS Telephone
PALS Date of Passing (ONLY if in memoriam)
3. The Permission Waiver
By my own personal authority or power of attorney, I give permission to use the photograph of submitted to the ALS/MND March of Faces to be printed on the ALS/MND March of Faces Banner for the International Alliance Meeting for the purpose of awareness and advocacy.
Signature Date
Someone else may sign for the person with ALS/MND
................
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