By my consent given below, I hereby authorize Phoebe Ministries to take and utilize photographs and/or video of me for purposes including but not limited to: Marketing/Publicity (The Phoebe Messenger, newsletters, display boards, print ads, billboards, and other publications), Social Media (company Facebook, YouTube, and LinkedIn pages), Media/News Organizations (newspaper or television), Education/Teaching, Performance Improvement/Peer Review, Law Enforcement, Research, other.

Photo Release Form

Name(Required)
MM slash DD slash YYYY
Please upload a recent headshot, so that we may easily identify you in photographs.
Max. file size: 3 MB.
Typing your full name below signifies that you are completing this form using an electronic signature. By signing electronically you are certifying that you agree to electronically sign and give permission for Phoebe to use your photograph and/or video in the communications listed above. To continue with the electronic signature process, please enter your name and click the "Sign Electronically" button to submit your electronic signature.