Public Affairs Release Form
Date: ___________________________
I authorize Galveston College to use my name, statements and likeness, without charge, for
promotional purposes in college publications, advertising, video, web, new media or other
formats.
Name: _______________________________________________________________________________
Signature: ____________________________________________________________________________
E-mail Address: ________________________________________________________________________
Phone: _______________________________________________________________________________
Address: _____________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
If under 18, parent name and signature also required:
Parent’s Name: ________________________________________________________________________
Signature: ____________________________________________________________________________
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click to edit
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