Paul Revere Chapter DAR Photo and Video Release Form
I hereby grant permission to the National Society Daughters of the American Revolution (NSDAR), including any of its chapters or state societies, to publish photos/images/videos including my name or the name of my child in press releases and/or other materials either in print or electronic format for purposes deemed appropriate by the NSDAR.

By completing this form, I am electronically signing this release form with the knowledge that any photos/images/videos posted electronically and in press releases can be downloaded and reprinted by news organizations, individuals and others including print, electronic, and broadcast media, and I, therefore, release the NSDAR from any liability arising from use of my or my child’s photos/images/videos in web postings.

I further understand that if I wish to rescind this agreement, I may do so at any time by sending a letter to NSDAR. I further understand that already published photos/images/videos cannot be recalled.

The requested rescission will take effect upon receipt of the notification.

Email address will be collected for correspondence related to this release, if necessary. You will not be added to a mailing list.

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Email *
Full Name (First and Last) *
If applicable, name of minor child:
Phone Number
Repurposed from:
Document No. NSDAR-1000 (April 2018) (0518-GD)
National Information Packet 2018  PART II
National Society Daughters of the American Revolution
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