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Clean Up America

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Name *
Name
Address *
Address
City & State
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I grant permission and consent for the American Conservation Coalition to use any photographs taken of me during the Clean Up America project for presentation or use under any legal condition, including but not limited to: publicity, copyright purposes, illustration, advertising, and web content. If I deny permission and consent, I recognize that I must inform ACC whenever a photograph of me appears in ACC materials. ACC acknowledges that it will take all reasonable measures to stop use of any photographs of me after I provide notice.
Parent/Guardian Consent
If you are under the age of 18, consent from your parent or guardian must be given.
Check One *
Legal Guardian's Name
Legal Guardian's Name
I grant permission and consent for the American Conservation Coalition to use any photographs taken of me during the Clean Up America project for presentation or use under any legal condition, including but not limited to: publicity, copyright purposes, illustration, advertising, and web content. If I deny permission and consent, I recognize that I must inform ACC whenever a photograph of me appears in ACC materials. ACC acknowledges that it will take all reasonable measures to stop use of any photographs of me after I provide notice.