Page 67 - District 20-K1 Kings & Queens Fall Edition November 2021
P. 67
DISTRICT 20-K1 HISTORY BOOK RELEASE FORM
I/We, member/s of_____________________________________________________ Club,
grant permission to District 20-K1 of Lions Clubs International to use the image and
information attached dated …………………… for use in the publication of the District 20-k1
History Book.
I/We hereby waive any right to inspect or approve the finished publication that may be used
ANNOUNCEMENT
whether that use is known to me or unknown, and I/we waive any right to royalties or other
compensation arising from or related to the use of the publication.
Please initial the paragraph below which is applicable to your present situation:
_____ I am/We are 18 years of age or older and I am/we are competent to contract in
my/our own name. I/We have read this release before signing below, and I/we fully
understand the contents, meaning, and impact of this release. I/We understand that I
am/we are free to address any specific questions regarding this release by submitting those
questions in writing prior to signing, and I/we agree that failure to do so will be interpreted
as a free and knowledgeable acceptance of the terms of this release.
_____ I am/We are the parent or legal guardian of the below-named child. I/We have read
this release before signing below, and I/we fully understand the contents, meaning, and
impact of this release. I/We understand that I am/we are free to address any specific
questions regarding this release by submitting those questions in writing prior to signing,
and I/we agree that failure to do so will be interpreted as a free and knowledgeable
acceptance of the terms of this release.
Signature: ____________________ Name (please print): __________________________
Signature: ____________________ Name (please print): __________________________
Signature: ____________________ Name (please print): __________________________
Signature: ____________________ Name (please print): __________________________
Leo Name (please print): __________________________
Signature of parent or legal guardian: ________________________________
(if Leo is under 18 years of age)
Leo Name (please print): __________________________
Signature of parent or legal guardian: ________________________________
(if Leo is under 18 years of age)
Date:______________________
