Used to protect privacy and fight against discrimination in marketing materials. Friendship Industries.

1. October 5, 2006
MEDIA RELEASE
As a contribution to the fight against discrimination against people with
disabilities, and public awareness raising efforts, permission is hereby
granted to Friendship Industries, Inc. to use and distribute photographs,
slides, my voice, videos or other electronic media taken of me to use in
promotional materials for the agency, which may include, but is not limited
to, the following:
1. Brochures
2. Articles
3. Advertising
4. Video presentations
5. Electronic media used on the web site
I understand that the material will be used for the purpose of publicity,
education, fighting discrimination against people with disabilities, to help the
public understand the mission of Friendship Industries, advertising the
capabilities of the operations, fund raising, for historical purposes of the
agency, and to recruit clientele and employees.
It has been explained to me that I have the right to choose not to have my
picture or video taken and that my participation is considered granting of
permission, without limitation or reservation.
Signature of Employee Date
Printed Name of Employee
Signature of Guardian Date
Person Explaining Form Date
Phone: 540/434-9586