Media Consent & Release Form
I, __________________________________________, do hereby irrevocably grant the Michigan (name of parent/guardian)
Music Education Association (hereafter referred to as “MMEA”) and NAfME: The National Association for Music Education (hereafter referred to as “NAfME”), and their agents, the right to use any/all photographs, video and/or audio recordings, original compositions and/or artwork in print and/or recorded form, and any/all biographical information associated with my student,
___________________________________________, for the purpose of display, exhibition (name of student)
and/or advertisement in any form of print, graphic, online, broadcast, webcast and/or print media of MMEA and/or NAfME. In granting these rights, I hereby agree that MMEA and/or NAfME may use all such media, now and in the future, and I waive all claims against MMEA and NAfME for any/all gains and/or liability that may arise in connection with such use. By signing below, I hereby attest that I have read this agreement, understand its terms, and agree to be legally bound by it.
Parent/Guardian Signature: Student Signature: Date: Date:
MMEA • 1006 W. Washington Avenue Jackson, MI 49203 •
www.mmeamichigan.org • (517) 748-6518
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