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Photo/Video Consent Form

I hereby grant permission to the University of Kentucky College of Health Sciences and its affiliates and subsidiaries to interview, photograph, and/or videotape me and/or to use and/or permit others to use information from the aforementioned interview and/or the aforementioned images in educational and promotional activities for the following without compensation: University or College Educational Publications/Videos; University or College Electronic Publishing (e.g. website, email newsletters, podcasts); University or College Social Media Initiatives; University or College Promotion/Advertising (e.g. magazines, flyers, bulletin board designs); Local/regional/national news media (w/permission of the University of Kentucky College of Health Sciences).

By typing your name, you are providing your digital signature.