Media Release Forms

I hereby consent and authorize the Traverse City Seventh Day Adventist Church or its assigns, to use my name and/or the names of my family members who are minors, as listed below, as well as my likeness, photos, videos and other information (or that of family members who are minors) for the purpose of news releases, advertising, publicity, publication or distribution in any manner whatsoever. I further consent Traverse City Seventh Day Adventist Church to such use in their present form and to any changes, alterations, or additions thereto. I hereby release the from all liability in connection with all such uses.

Please include the names of all members of your family.

Traverse City Church Media Consent

Company

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Name*

First Last

Name

First Last

Name

First Last

Name

First Last

Name

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date*