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CMIT Application Signature- Photo/Video Release

Photo/Video Release

I release to Chi Alpha Campus Ministries, U.S.A. the right to utilize my photo or a video of myself during the internship program. I understand Chi Alpha will utilize only tasteful and appropriate images that help communicate the vision, values, and mission of Chi Alpha Campus Ministries, U.S.A.

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I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

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Chi Alpha Campus Ministries https://chialpha.com

Timestamp

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August 31, 2017 3:53 pm CDT

CMIT Application Signature- Photo/Video Release Uploaded by CMIT Program - cmit@ag.org IP 66.119.29.16, 127.0.0.1

December 6, 2017 12:40 pm CDT

Document owner mlynch@ag.org has handed over this document to XAAffiliations@ag.org 2017-12-06 12:40:23 - 66.119.29.16

November 26, 2018 4:39 pm CDT

Document owner XAAffiliations@ag.org has handed over this document to cmit@ag.org 2018-11-26 16:39:25 - 66.119.29.16, 127.0.0.1