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I attest that these images were captured in accordance with any applicable laws, regulations, policies, or rules. I attest that I am sending the image(s) in my capacity as an individual, and am not portraying myself to be an agent of any company, business or enterprise that may be depicted. As far as I am aware, all persons depicted are 18 years of age or older, or are not shown in a reckless or scandalous manner that might bring any disrepute to them or their guardians.

I hereby grant the IAMAW District 141, its directors, officers, employees, agents, and designees (collectively “The Union, The District, the IAM, The IAMAW, etc.”) non-revocable permission to use my image and likeness in videotapes, motion pictures, recordings, or any other media (collectively “Images”). I acknowledge that District 141 will own such Images and further grant the District 141 permission to copyright, display, publish, distribute, use, modify, print and reprint such Images in any manner whatsoever related to Union business, including without limitation, publications, advertisements, brochures, web site images, or other electronic displays and transmissions thereof. I further waive any right to inspect or approve the use of the Image by District 141 prior to its use. I forever release and hold District 141 harmless from any and all liability arising out of the use of the Images in any manner or media whatsoever, and waive any and all claims and causes of action relating to use of the Images, including without limitation, claims for invasion of privacy rights or publicity.

I hereby warrant that I am eighteen (18) years old or more and competent to contract in my own name or, if I am less than eighteen years old, that my parent or guardian has signed this release form below. This release is binding on me and my heirs, assignees and personal representatives.