ࡱ> 9;8M bjbjcc . we we 8?S,(oC C C 7,9,9,9,9,9,9,$/2],C 1C C C ],r,###C F7,#C 7,##*|s+@Ud  +#,,0,+Z(3 !(3$s+(3s+C C #C C C C C ],],"<C C C ,C C C C (3C C C C C C C C C : (PLEASE NOTE: THIS IS A SAMPLE MEDIA RELEASE FORM CREATED FOR THE AMERICAN LIBRARY ASSOCIATION AND MAY REQUIRE REVISION FOR YOUR ORGANIZATIONS NEEDS. PLEASE ENSURE THAT YOU ARE COMPLYING WITH ALL PRIVACY OBLIGATIONS OF YOUR LIBRARY AND PARTNER ORGANIZATION, AS WELL AS THE WISHES OF PROGRAM PARTICIPANTS.) Photo Release Agreement I hereby consent to the use of my name, photograph, and/or likeness by (INSERT LIBRARY NAME AND PARTNER ORGANIZATION NAME) (Owners) for any purpose and in any manner, including the purposes of advertising and/or trade in any and all media, including the Internet, throughout the world, without restriction as to frequency or duration of usage. The Owners shall be the absolute owners of any materials (and all rights therein, including the copyright) produced pursuant to this agreement. I understand and accept that I will not receive any monetary compensation for any photographs, material, or likenesses, or their use, neither now nor at a later date. I hereby release the Owners and any third parties involved in the creation, publication or use from liability for any claims by me or any third party in connection with use of the photographs, name and likeness. I hereby warrant and represent that I am at least 18 years of age*, and have the full right to contract in my own name with respect to the matters stated above.  Name (print) Signature Date Street Address City State Zip * Complete if individual is under 18: I, the undersigned, warrant and represent that I am the parent or legal guardian of , whose signature appears above. I have read the above release agreement and am fully familiar with the contents thereof, and I hereby grant my permission and consent to all of the contents above. Name (print) of parent or legal guardian Signature Date Street Address City State Zip  ADVANCE \y 736 CHDS01 MAV 979443v1     x 2 3 5  Z [ \ ] +-lm~Ͼgggggggg0jh2h)CJOJQJUaJmHnHuh2hCJOJQJaJh2h)5CJOJQJaJh2hW)5CJOJQJaJh2h)CJOJQJaJ h2hkCJOJQJ^JaJh2he5OJQJh2hy5OJQJh2hFj5OJQJh2hW)5OJQJ&3 4 5 M N X Y Z \ ^gd) $^a$gd)  !^gdk  !gdygdW) e()*+jkl|}~   ^gdo  !^gdk^gd);h)h2jh2Uh2hkCJOJQJaJh2hCJOJQJaJ%jh2hCJOJQJUaJ h2hCJOJQJ^JaJgdo,&P/ =!"#$% w2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@6666_HmH nH sH tH 8`8 Normal_HmH sH tH 8@8  Heading 1$@&CJBB  Heading 2$$@&a$5CJZZ  Heading 3$$ f)*$@&a$5@CJ8OJQJDA D Default Paragraph FontViV  Table Normal :V 44 la (k (No List VOV Return Addressd8  @ CJOJQJJJ Return Address Dark5@:: OfficeFrom$a$CJ0"0 WhoFrom$a$0U 10 Hyperlink>*B*TPBT Body Text 2$ 0*$a$@CJOJQJHBRH Body Text$ 0*$a$@CJ4@b4 Header  !4 r4 Footer  !J^J Normal (Web)dd[$\$CJaJLCL Body Text Indent ^CJaJPRP Body Text Indent 2 ^CJaJ*W * Strong5\HH  Balloon TextCJOJQJ^JaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭VGRU1a$N% ʣꂣKЛjVkUDRKQj/dR*SxMPsʧJ5$4vq^WCʽ D{>̳`3REB=꽻Ut Qy@֐\.X7<:+& 0h @>nƭBVqu ѡ{5kP?O&Cנ Aw0kPo۵(h[5($=CVs]mY2zw`nKDC]j%KXK 'P@$I=Y%C%gx'$!V(ekڤք'Qt!x7xbJ7 o߼W_y|nʒ;Fido/_1z/L?>o_;9:33`=—S,FĔ觑@)R8elmEv|!ո/,Ә%qh|'1:`ij.̳u'k CZ^WcK0'E8S߱sˮdΙ`K}A"NșM1I/AeހQתGF@A~eh-QR9C 5 ~d"9 0exp<^!͸~J7䒜t L䈝c\)Ic8E&]Sf~@Aw?'r3Ȱ&2@7k}̬naWJ}N1XGVh`L%Z`=`VKb*X=z%"sI<&n| .qc:?7/N<Z*`]u-]e|aѸ¾|mH{m3CԚ .ÕnAr)[;-ݑ$$`:Ʊ>NVl%kv:Ns _OuCX=mO4m's߸d|0n;pt2e}:zOrgI( 'B='8\L`"Ǚ 4F+8JI$rՑVLvVxNN";fVYx-,JfV<+k>hP!aLfh:HHX WQXt,:JU{,Z BpB)sֻڙӇiE4(=U\.O. +x"aMB[F7x"ytѫиK-zz>F>75eo5C9Z%c7ܼ%6M2ˊ 9B" N "1(IzZ~>Yr]H+9pd\4n(Kg\V$=]B,lוDA=eX)Ly5ot e㈮bW3gp : j$/g*QjZTa!e9#i5*j5ö fE`514g{7vnO(^ ,j~V9;kvv"adV݊oTAn7jah+y^@ARhW.GMuO "/e5[s󿬅`Z'WfPt~f}kA'0z|>ܙ|Uw{@՘tAm'`4T֠2j ۣhvWwA9 ZNU+Awvhv36V`^PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!g theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] C    T@   @H 0(   (  \B  C D#" ?\B  C D#" ?\B  C D#" ?\B  C D#" ?\B  C D#" ?\B  C D#" ?\B  C D#" ?\B   C D#" ?VB   C D"?B S  ?Z\+,l~'tt't't k&t'tt't 't-8ad 3333323355vv::hhx**,-88aijjkklm{{}}~23355vv::hhx**,-88aijjkklm{{}}~?H EH  FaIhs81^ Xp L AuѮ^ hh^h`OJQJo( hh^h`OJQJo(h ^`OJ QJ o(oh ^`OJ QJ o(oh pp^p`OJ QJ o(h @ @ ^@ `OJQJo(h ^`OJ QJ o(oh ^`OJ QJ o(h ^`OJQJo(h ^`OJ QJ o(oh PP^P`OJ QJ o(hh^h`)hh^h`)h^`OJQJo(hHh^`OJ QJ ^J o(hHohpp^p`OJ QJ o(hHh@ @ ^@ `OJQJo(hHh^`OJ QJ ^J o(hHoh^`OJ QJ o(hHh^`OJQJo(hHh^`OJ QJ ^J o(hHohPP^P`OJ QJ o(hHXp?Hs81^XpL Au FaI                  &%s]LQWhW)#6&]HryiAyeh{two|AFjt 7AoiM[2k*-Fa./d]lyd?c_)@4444@Unknown G*Ax Times New Roman5Symbol?. *Cx ArialArial7.@CalibriU"Univers (PCL6)UniversEUniv45CalibriY CG TimesTimes New Roman5..[`)TahomaC.,{ @Calibri Light?= *Cx Courier New;WingdingsA$BCambria Math"hgg9''!24 3QHP?k2! xxrTs American Library Association Judy Crowley Sarah Ostman$      Oh+'0 ( H T ` lx 91ýJudy Crowley Normal.dotmSarah Ostman2Microsoft Office Word@@@m=d @m=d '՜.+,0  hp   91ý 91ý Title  !"#$%&')*+,-./1234567:Root Entry FѶUd <1TableL3WordDocument.SummaryInformation((DocumentSummaryInformation80CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q