"Untold Stories from Iraq & Afghanistan" A Graphic Novel

PHOTO/STORY RELEASE FORM

Clayton D. Murwin
209 Atlantic Avenue
Broadway ,VA. 22815

Instructions: Please review the criteria of this Release, complete it and return it to Clayton D. Murwin If you have any questions regarding the Release, please contact Clayton D. Murwin cmerwin6@gmail.com or 540-271-1244. Thanks for your involvement and support.

Project Name (if applicable): Untold Stories From Iraq ,A Graphic Novel

Address: 209 Atlantic Avenue
Broadway,VA. 22815

Coordinator: Clayton D. Murwin/Victor Castro
Signature: Clayton D. Murwin

STORY RELEASE
I hereby consent to and authorize the use and reproduction, in print or electronic format by Clayton D. Murwin and other members/agencies, involved in the “Untold Stories from Iraq & Afghanistan",  Graphic Novel project to benefit the fallen and injured soldiers and their families to use all and/or part of my story for promotional and educational uses, without compensation. I agree that Clayton D. Murwin may use such story about me with or without my name for any lawful purpose including, but not limited to: publicity, illustration, advertising and Web content.

Please indicate if you would like your name to be changed for client confidentiality: YES NO

I have read and understand the above:

Signature: ____________________ Printed Name: ______________________ Date: _______

Signature, parent or guardian (if under age 18): __________________________ Date: _______


PHOTO RELEASE
I hereby consent to and authorize the use and reproduction, in print or electronic format by Clayton D. Murwin and other members/agencies, involved in the “Untold Stories from Iraq, A Graphic Novel” project, to include photographs of me which have been taken for the promotional and educational uses, without compensation. I agree that Clayton D. Murwin and other members/agencies, involved in the “Untold Stories from Iraq & Afghanistan",  Graphic Novel may use such photographs of me with or without my name for any lawful purpose including, but not limited to: publicity, illustration, advertising and Web content.

I have read and understand the above:

Signature: ____________________ Printed Name: ______________________ Date: _______

Signature, parent or guardian (if under age 18): __________________________ Date: _______

_________, in Untold Stories From Iraq & Afghanistan",  Graphic Novel Project to benefit the fallen & injured soldiers from the Iraq & Afghanistan war for  print publications, website and promotional materials, and in any and all other media, whether now known or hereafter existing, controlled by Clayton D. Murwin and other project members, in perpetuity. I will make no monetary or other claim against Clayton D. Murwin and other project members for the use of my original work, except where stipulated in a contract signed by all parties involved.
Name: __________________________________________
(print full name)
Signature: __________________________________________
Date: __________________________________________
Relation to artist: __________________________________________
(if artist is a minor)
Address: __________________________________________
City, province, postal code: __________________________________________
Telephone: __________________________________________
Email: __________________________________________