Publicity Release Form - Purdue Marketing and Communications

I

grant permission to Purdue University and its agents and employees the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of me, or members of my family, for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium. I hereby release Purdue University and its legal representatives for all claims and liability relating to said images or video. Furthermore, I grant permission to use my statements that were given during an interview or guest lecture, with or without my name, for the purpose of advertising and publicity without restriction. I waive my right to any compensation.

I acknowledge that I am*

over the age of 18
the legal guardian of the following

Name(s) of Minors*

Signature

Address

Street Address City State ZIP Code