The undersigned does hereby authorize
THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
and/or its associates, assistants, or subcontractors to photograph/film
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Name (please print)
The undersigned authorizes The Regents of the University of California to permit the use and display of said photographs in any publication, multimedia production, display, advertisement or World-Wide Web Publication for Information Systems and Technology or its constituent departments.
The undersigned agrees that the Regents of The University of California may use name, likeness, or biographical information supplied by the undersigned.
The undersigned releases and forever discharges The Regents of the University of California, its agents, officers and employees from any and all claims and demands arising out of or in connection with the use of said photographs / images, including but not limited to, any claims for invasion of privacy or defamation.
Accepted and Agreed:
___________________________________________
Signature of Subject
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Signature of Witness
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Date