Is Your Well Safe? Understanding Arsenic Contamination

Thank you for attending a program hosted by Women for Healthy Rural Living (WHRL). This photo release form is optional. Please direct any questions to our experience coordinator at lizzie@psi.mzh.mybluehost.me or (207)-546-7677.

I hereby give permission for images and/or videos of myself taken during this program to be used by Women for Healthy Rural Living in any and all of its publications, including web-based publications, without payment or other consideration.

I understand and agree that all photos will become the property of WHRL and will not be returned. WHRL can edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.

I hereby hold harmless, release, and forever discharge WHRL from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.