John Wesley A.M.E. Zion Church

28001 Evergreen

Southfield MI 48076

Permission to Use Photograph

Subject: ____________________

Location: ___________________

I grant to JOHN WESLEY A.M.E. ZION CHURCH, its representatives and employees the right to take photographs of me and my property in connection with the above-identified subject. I authorize JOHN WESLEY A.M.E. ZION CHURCH, its assigns and transferees to copyright, use and publish the same in print and/or electronically.

I agree that JOHN WESLEY A.M.E. ZION CHURCH may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

I have read and understand the above:

Signature _________________________________

Printed name ______________________________


Name (if applicable) __________________________

Address __________________________________

Date _____________________________________

Signature, parent or guardian _______________________ (if under age 18)