Name *

First Name

Last Name

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Address *

Address 1

Address 2

City

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I hereby grant permission to the Women's Diplomatic Series, Inc. (WDS), to take and use: photographs and/or digital images of me individually or group photographs in which am included at WDS-sponsored events for use in promotional, educational and informational materials. These materials might include printed or electronic publications, Web sites or other electronic communications. I further agree that my name and identity may be revealed in descriptive text or commentary in connection with the image(s). I authorize the use of these images without compensation to me. All negatives, prints, digital reproductions shall be the property of WDS. I release WDS and its representatives from liability for any claim or course of action resulting from or in any way related to the use or publication photographs or images. Check a box below. *

I grant permission to above.

I do not grant permission to above.