Release to use photograph or video footage

Complete and submit online. You can also print this page, complete the form, and either email or mail the form to: lib-communication@uiowa.edu; Mail: UI Libraries Communication Office 5066 LIB, Main Library, University of Iowa, 125 West Washington Street, Iowa City, IA 52242

Name of UI Libraries patron:*
First Last
Date*
MM slash DD slash YYYY

The date the picture was taken
Location photo or video was taken:*
Name of photographer/videographer:*
First Last
Permission*
I give permission to use photos and or video footage of me taken on the date listed above, by the photographer/videographer listed above, at The University of Iowa Libraries. I am releasing these photographs and or video footage to be published by the photographer/videographer in print, web, and social media.
- By selecting this box I give my permission