Chemical Education Xchange Model Release Form
I am preparing material to be published at Chemical Education Xchange (www.ChemEdX.org), an online community of chemistry educators.
I would like your permission to include a copy of the attached photograph(s) in which you appear. To indicate your permission, please sign and date the statement below and return this form to me.
I appreciate your prompt response.
I hereby grant Chemical Education Xchange royalty-free permission, including non-exclusive world rights in all languages, to reproduce in all formats including but not limited to print, electronic and web-based to reproduce and include my likeness as shown in the attached photocopy(ies) of photograph(s) for Chemical Education Xchange.
Agree to and accepted:
_____ I am the person in the photograph(s).
_____ I am the authorized agent of the person in the photograph(s).
Submit this completed form to _________________________