Name *

First Name

Last Name

Phone *

(###)

###

####

I confirm that: *

• I am the owner of the submitted photo(s) OR have permission to grant usage rights. • I understand that the images may be used for promotional and educational purposes, and no identifying names will be shared unless explicitly agreed upon. • This permission is non-exclusive, meaning I retain the rights to my images and may use them elsewhere. • I acknowledge that I will receive an honorarium per selected image as a token of appreciation. • I understand that Due North Support Services LLC will not sell or distribute the images to third parties.

Yes

No

Acknowledgement *

I understand that submitting this form does not create a commitment on either party’s part and that my photos will only be used if I receive confirmation from Due North Support Services LLC. If my photos are selected, I will be informed of how they will be used and when to expect my honorarium.

I Understand