This document is a release and authorization form for the Sedona Historical Society to photograph, videotape, or audiotape an individual and use the materials for exhibits or other purposes consistent with the Society's mission. By signing, the individual agrees to allow indefinite use of the materials and releases the Society from any claims regarding their use, including claims for damages from libel or invasion of privacy.
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Release for taping or photo2
1. RELEASE & AUTHORIZATION TO PHOTOGRAPH, VIDEOTAPE OR AUDIOTAPE
SEDONA HISTORICAL SOCIETY
P.O. Box 10216, Sedona, Arizona 86339, 928-282-7038
www.sedonamuseum.org sedonamuseum@esedona.net
I, ____________________________________________________________ hereby agree to be
photographed, tape recorded and/or video taped by the Sedona Historical Society or its duly
authorized representative, and forever authorize the Sedona Historical Society to use and display
the photographs, tape recordings or video tapes as part of any exhibit or for any purpose or use
that is consistent with the purposes of the Sedona Historical Society and the Sedona Heritage
Museum. The undersigned does hereby irrevocably grant the Sedona Historical Society and their
successors or assigns these rights to use in perpetuity.
I hereby forever release and discharge the Sedona Historical Society, and its members, directors
and officers from any claim I may have for compensation of any type which I might be entitled
to for the use, display or publication of photographs, tape recordings and videotapes.
I hereby forever release the Sedona Historical Society and its members and the Sedona Heritage
Museum from any and all claims for damages for libel, slander, invasion of privacy, or any other
claim based on the use of said material(s).
Name:__________________________________________________________________
Address:________________________________________________________________
City, State, ZIP:__________________________________________________________
Phone: _________________ email: _________________________________________
Description of materials: _________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Signature: _____________________________________ Date:_________________
2010.03