Mankindpride.com: "Talk To A Man" Volunteer Data & Photo Submission and Release

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Data submitted on this form will be published on the mankindpride website.

First Name *

Last Name *

Phone Number *

Please format like this (415) 483-5838

City/State *

What was the date & location of your weekend? *

For verification only, will not be published.

Email address that you use within mkpconnect. *

For contact only purposes only, will not be published.

I consent and give my permission to have the data submitted on this form on the mankindpride and mankindproject websites. *

ACKNOWLEDGED AND AGREED

I consent to the ManKind Project to use my image for training, educational, and marketing purposes in any medium that it sees fit, including displaying such works in a public forum. By use of this electronic form I consent and waive any interest I might have in my likeness or other aspect of such images. *

ACKNOWLEDGED AND AGREED

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