General Media Release Form

By signing this form, I, the undersigned, hereby authorize C4 Atlanta to use my photograph, take motion pictures of me, take video footage of me, and/or make electronic sound recordings of me (herein referred to as photographic or electronic reproductions).

I authorize the use of any such photographic or electronic reproductions of me for any purpose, including, but not limited to educational and other public media as may be deemed appropriate by C4 Atlanta (I understand that I may be identifiable from such photographic or electronic reproduction). Photos will not be sold.