Form

JLM Media Consent & Release Form

Please complete the media consent and release form below:

I understand that I and any accompanying minor child(ren) may be photographed during Junior League of Memphis activities. I grant full and unlimited permission to the Junior League of Memphis, and its agents and affiliates to use my and/or my child(ren)’s name, photographs or any other record of participation in Junior League of Memphis activities in any publication, broadcast, telecast, social media or other account of the Junior League of Memphis activities for publicity purposes, without compensation.

Select one below:

I Consent

I DO NOT Consent

Full Name

Phone Number

Date of Birth

Which JLM event/program are you participating in?

If you selected "Other," please specify.

If you have any minors with you, please list their name(s) and date(s) of birth below.

Signature (Type Full Name Below)

Today's Date

Cancel