PHOTO RELEASE FORM

I hereby grant permission to The Mayfly Project to use photographs and/or video of me taken on Sunday, October 28 at Rose River Farm, in Syria, Virginia in publications, news releases, online, and in other communications related to the mission of The Mayfly Project.

I have read and understand the above photo release. I affirm that I am at least 18 years of age, or, if I am under 18 years of age, have obtained the required consent of my parents/guardians as evidenced by their electronic signature below.

Name - Electronic Signature *
Name - Electronic Signature
Minor's Name If Applicable
Minor's Name If Applicable
Date *
Date
I accept the terms of this waiver. *