Photo Opt-Out Form
Name
*
First Name
Last Name
Email
*
example@example.com
Location
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Confirm the following:
*
Please do not use images or recordings of me in the manners detailed in
PAMED's photo/video authorization policy.
Submit
Should be Empty: