Dates of Photo/Video Shoot:LocationName(Required) First Last Phone(Required)Email(Required) Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Terms(Required) I agreeIn consideration of my engagement as a model or subject, upon the terms herewith stated, I hereby give to Santa Rosa Economic Development, its legal representatives, and assigns: a) The unrestricted right and permission to copyright and use, re-use, publish, and republish photographic images and/or video-recorded content of me in which I may be included intact or in part, composite or distorted in character or form, in any and all media now or hereafter known for illustration, art, promotion, advertising, trade, or any other purpose whatsoever. I also permit the use of any printed or electronic material, including Internet usage and social media, in connection therewith. b) I hereby relinquish any right that I may have to examine or approve the completed product or products or the advertising copy or printed or electronic matter that may be used in conjunction therewith or the use to which it may be applied. c) I hereby release, discharge and agree to save harmless the photographer/videographer, his/her heirs, legal representatives or assigns, and all persons functioning under his permission or authority, from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form whether intentional or otherwise, that may occur or be produced in the taking of said picture(s) or in any subsequent processing thereof, as well as any publication thereof, including without limitation any claims for libel or invasion of privacy. d) As a model, I agree that the above mentioned photographs and video, and any reproductions thereof, shall be deemed to represent an imaginary person, and further agree that Santa Rosa Economic Development or any person authorized by or acting on its behalf may use the above mentioned photographs or any reproductions of them for any advertising purposes or for the purpose of illustrating any wording, and agree that no such wording shall be considered to be attributed to me personally unless my name is used. e) As a subject, I agree that the photographs and video taken of me may be used to illustrate my own story for purposes of furthering Santa Rosa’s economic development marketing and mission. I agree that the above mentioned photographs and video, and any reproductions thereof, in which I appear or speak, represent my independent thoughts and individual opinions, and further agree that Santa Rosa Economic Development or any person authorized by or acting on its behalf may use the above mentioned photographs or any reproductions of them for any advertising purposes or for the purpose of illustrating any wording, and agree that no such wording shall be considered to be attributed to me personally unless my name is used. e) I hereby affirm that I am over the age of majority and have the right to contract in my own name. I have read the above authorization, release, and agreement, prior to its execution; I fully understand the contents thereof. This agreement shall be binding upon me and my heirs, legal representatives, and assigns. Signature05/20/2026