Authorization to reproduce physical likeness/voice/name/creative work For Educational, Marketing and Advertising Purposes FOIP Statement Protection of Privacy – The personal information requested on this form is collected under the authority of Section 33 (c) of the Alberta Freedom of Information and Protection of Privacy Act (“Act”) and will be protected under Part 2 of the Act. The information is collected for the purpose of promoting the University of Lethbridge Faculty of Fine Arts programs, events and experiences. If you have any inquiries in regards to the collection of your personal information, please direct those inquiries to: FOIP Coordinator, University of Lethbridge, 4401 University Dr. West, Lethbridge, Alberta T1K 3M4, telephone: 403-332-4620, email: foip@uleth.ca. As a general rule all types of intellectual property created by faculty members of the University of Lethbridge is owned by the individual who created it in accordance with Article 18 of the University of Lethbridge Academic Staff Collective Agreement, and the above authorization shall be construed as a license to use and not as a transfer of ownership of copyright in such cases and in other cases where copyright is not held by the University but by the party granting authorization. This form will be retained and disposed of in accordance with approved records retention and disposal schedules of the University of Lethbridge. Form Details I hereby grant to the University of Lethbridge, including its employees, agents, assigns, or other third party as the University may authorize on its behalf, the nonexclusive right to: Agreement * Photograph me and/or my creative work Make recordings of my voice Make combined audio-visual recordings of me, my voice, and/or my creative work I authorize the University of Lethbridge Faculty of Fine Arts to use designated photographs, videos or audio (captured on or off campus, or provided by participant) taken, to be taken or provided during the 2024-2025 academic year for the purpose of promoting the University of Lethbridge Faculty of Fine Arts programs, events and experiences. Distribution will be made by/through the University of Lethbridge’s website, printed materials, social media outlets, and/or other electronic media in the period 2024 – 2031. Contact Details Full Name * Email Address * Are you: * Please SelectUniversity of Lethbridge StudentUniversity of Lethbridge Faculty MemberCommunity Member Student Course: * Instructors Name: * Submitting Project Documentation 1: Upload Image, audio, doc -- For Video Links include them in a text document More informationFiles must be less than 12 MB. Allowed file types: gif jpg jpeg png txt pdf doc docx mp3 wav. Documentation 2: Upload Image, audio, doc -- For Video Links include them in a text document More informationFiles must be less than 12 MB. Allowed file types: gif jpg jpeg png txt pdf doc docx mp3 wav. Documentation 3: Upload Image, audio, doc -- For Video Links include them in a text document More informationFiles must be less than 12 MB. Allowed file types: gif jpg jpeg png txt pdf doc docx mp3 wav. Documentation 4: Upload Image, audio, doc -- For Video Links include them in a text document More informationFiles must be less than 12 MB. Allowed file types: gif jpg jpeg png txt pdf doc docx mp3 wav. Additional Documentation: Upload Image, audio, doc -- For Video Links include them in a text document More informationFiles must be less than 12 MB. Allowed file types: gif jpg jpeg png txt pdf doc docx mp3 wav. Leave this field blank Submit