4-H Alumni Story

 

 

 

answer must be an email address

 

answer must be phone number with area code like 217-333-1000

 

 

 

 

Please list county and state

Please list county and state

 

 

Please list school attended, degree(s), graduation dates (ie. University of Illinois, B.S. '75 Ag Education; M.S. '80 Crop Sciences or a technical degree obtained)

Please list school attended, degree(s), graduation dates (ie. University of Illinois, B.S. '75 Ag Education; M.S. '80 Crop Sciences or a technical degree obtained)

Please upload a head/shoulder photo of yourself. By uploading a photo you agree to allow use by the Illinois 4-H program.

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Talent Release Form 
I, the undersigned, do hereby consent to the use by The Board of Trustees of the University of Illinois (“University”) of my image,
voice, or both described below, in (1) the video, photograph, or audio recording described below; and (2) any video, photograph, or
audio recording reproduced either in whole or in part from the video, photograph or audio recording described below: regardless of
whether these materials are used for fundraising, advertising, publicity, or any other purpose on behalf of either the University or its
Foundation.I warrant that I have the full right and authority to grant this consent.

In addition, I waive all claims to compensation or damages based on the use of my image or voice, or both, by either the University or
the Foundation. I also waive any right to inspect or approve the finished photograph or video or audio recording.

I understand that this consent is perpetual, that I may not revoke it, and that it is binding on me, my heirs and assigns.

I warrant that I am at least 18 years of age and that I am competent in my own name insofar as this consent is concerned, or that I am
the parent or legal guardian authorized to sign on behalf of a person under age 18. I further attest that I have read this consent form
and fully understand its contents.

Talent Release Form 
I, the undersigned, do hereby consent to the use by The Board of Trustees of the University of Illinois (“University”) of my image,
voice, or both described below, in (1) the video, photograph, or audio recording described below; and (2) any video, photograph, or
audio recording reproduced either in whole or in part from the video, photograph or audio recording described below: regardless of
whether these materials are used for fundraising, advertising, publicity, or any other purpose on behalf of either the University or its
Foundation.I warrant that I have the full right and authority to grant this consent.

In addition, I waive all claims to compensation or damages based on the use of my image or voice, or both, by either the University or
the Foundation. I also waive any right to inspect or approve the finished photograph or video or audio recording.

I understand that this consent is perpetual, that I may not revoke it, and that it is binding on me, my heirs and assigns.

I warrant that I am at least 18 years of age and that I am competent in my own name insofar as this consent is concerned, or that I am
the parent or legal guardian authorized to sign on behalf of a person under age 18. I further attest that I have read this consent form
and fully understand its contents.

 

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