PHOTOGRAPHER RELEASE AND CONSENT FORM
I hereby grant the Society of Hispanic Professional Engineers (SHPE), its representatives and employees the right to
take photographs and/or video of me and/or use a photo provided by me. I authorize SHPE, its assigns and
transferees to copyright, use and publish the same in print and/or electronically.
I agree that SHPE 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.
By signing below, I have read, understood, and agree to the above:
Full Name
SHPE Affiliation (Chapter Name and Title, if applicable)
If providing a photo, please provide a short description of said photo.
Signature
Date
E-mail
Primary Contact Phone Number
SHPE changes lives by empowering the Hispanic community to realize its fullest potential and
to impact the world through STEM awareness, access, support and development.
13181 Crossroads Parkway North, Suite 450 | City of Industry, California 91746 | (323) 725-3970 | shpe.org