EmailMeForm
Social Media Consent/Release Form
Please complete the release form below:
I hereby authorize IASA to use my photo and/or information related to me as a recipient of the 2019 Scholarship Award. I understand this information may be used in publications, including electronic publications, audiovisual presentations, promotional literature and other similar ways.
My consent is freely given as a public service to IASA, without expecting payment. I release IASA and their respective employees, officers and agents from any and all liability which may arise from the use of such news media stories, promotional materials, written articles , videotape and/or photographs.
I understand that I can revoke this release any time in writing and that the use of any of my photos or other information authorized by this release will immediately cease.
Please enter your name below as you would like it to appear in promotional materials.
I prefer that my
No Name be used
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