Media Release Form

Please use this form so Vote Bane can share your likeness.

For Vote Bane Official Use

I hereby give my consent for the image and likeness to be interviewed, videotaped, audiotaped, or photographed for the following uses:

  • Educational/Informational media
  • Engagement/Outreach media
  • Development media
  • Social media
  • Newsworthy media documentation

I further authorize Ronald L. Bane, Jr., Vote Bane, and/or Bane for Magistrate, and their authorized agents to use this electronic media and/or photographs in any manner-whole, or in part.

This waiver includes usage of this media in any way deemed appropriate, which may include electronic and photographical reproductions thereof for the production educational, informational, instructional, promotional, or other media materials which support the educational and outreach activities of West Virginia University.

I hereby waive any right I may have to inspect or approve any use of this electronic media and/or photographs and I release Ronald L. Bane, Jr., Vote Bane and/or Bane for Magistrates and its authorized agents from all liability which could result from its use.

Contact Us

If you have any questions about this Media Release Form, please contact me.

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