Photograph Permission Form

I authorize ________________________________________ to publish photographs, taken on _______________, of myself and/or my work, in print and electronic media including publication on any Society for Creative Anachronism, Inc. Recognized Internet web site, for any non-commercial purposes related to the SCA. This permission is given with no promise or expectation of anything of value in return.

SCAdian Name (please print) Modern Name (please print) Modern Signature E-mail Address