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2. PHOTOGRAPHY RELEASE, CONSENT & AUTHORIZATION FORM

   I hereby release, authorize, and grant the City of Rawlins, a Wyoming Municipal Corporation, along with its representatives, agents, employees, and community partners, the non-exclusive right to use, display, reproduce, and publish my photograph(s) for municipal and public purposes. This includes, but is not limited to, uses for publicity, illustration, advertising, social media, website content, and print publications. This authorization extends to the display of my photographs on any City- or community partner-related internet or social media platform, website, and print medium. I further affirm that I am the rightful owner of the photograph(s) or have obtained the necessary permissions from the owner of the photograph(s), and that the use of the photograph(s) will not violate any copyright, trademark, or other proprietary rights of any third party. I understand that this authorization does not entitle me to any payment, royalty, fee, or other compensation. I also acknowledge that I may revoke this authorization at any time by submitting written notification to the City of Rawlins; however, such revocation shall not apply retroactively to uses authorized prior to the receipt of this revocation. I further agree to release, indemnify, and hold harmless the City of Rawlins and its officers, employees, agents, and partners from any and all claims, liabilities, or damages arising out of or in connection with the use, reproduction, or display of my photograph(s) as authorized herein. This indemnification shall apply to any claim or action brought against the City by a third party asserting intellectual property, privacy, or other rights in connection with the authorized uses described in this release.

   I acknowledge that I have read and understood this release and authorization in full. By selecting "Yes" and providing my name and contact information, I signify my legal agreement to the terms herein.

4. Signature*

   I hereby acknowledge that I have read and understand the above and foregoing Release, Consent & Authorization. By selecting "Yes" and providing my name and contact information I am legally signing this form.

   1. Yes
   2. No
6. Date*
   Date
8. First Name*
9. Last Name*
11. Address1*
13. Address2
15. City*
16. State*
17. Zip*
19. Email
21. Phone Number
23. Note:
    Contact information will not be published with the photo. These are included for legal purposes of signing the form. Thank you!
25. Photo Upload

    File won't upload? Sign the form here and then email the file to crelations@rawlinswy.gov 

Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit Submit and Print

* indicates a required field