Campus Recreation Media Request Form
To protect the privacy of our participants, the use of photographic devices, including cell phone cameras and professional equipment, is not permitted at Campus Recreation facilities without prior permission from the Department of Campus Recreation. Permission may be requested by submitting a Media Request Form.

By submitting a Media Request Form, you understand that:
1. The form MUST be completed a minimum of 1 full business day in advance to your requested day/time.
2. Filling out this form does NOT guarantee approval for your request. You will be emailed regarding the status of your request.
3. If approved, you MUST inform anyone who appears in the photos/videos and receive his/her verbal consent prior to photographing/videoing. Violation of this requirement may result in the requestor presenting his/her media to a Campus Recreation staff member and/or the requestor being asked to discontinue photography/videography.
4. If approved, all photography/videography must be taken between the hours of 8am-2pm Monday-Friday.
5. If approved, Campus Recreation should receive access to all photographs/videos taken if requested.

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Name *
Email address *
Phone number *
What is your affiliation with the University of Mississippi? *
UM ID number
Select your media request(s) *
Who do you want to interview, photograph, or video? Please request a specific person(s) if possible. *
What is the purpose of your request? (i.e. to take pictures of someone engaging in physical activity and ask them a few questions about their workout routine for my journalism class) *
Location(s) for request (i.e. fitness center, lobby, etc.) *
Media request date(s) *
Media request time(s): *
If you indicated "other" for the media request time, please explain
What will your produced media be used for? *
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