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I AM ISRHML

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* 1. Name:

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* 2. Current Position:

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* 3. Time as a volunteer:

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* 4. Most meaningful contribution as a volunteer:

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* 5. Why do you volunteer at ISRHML?

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* 6. What do you like about volunteering at ISRHML?

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* 7. What do you do when you are not volunteering?

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* 8. What we might be surprised to know about you?

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* 9. How do you keep balance in life?

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* 10. What are you currently watching or reading?

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* 11. Please upload a high-resolution headshot (PNG or JPG, JPEG).

PNG, JPG, JPEG file types only.
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* 12. Please upload a high resolution photo of your institution (PNG, JPG, JPEG).

PNG, JPG, JPEG file types only.
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* 13. Photograph & Video Release Form

Without expectation of compensation or other remuneration, now or in the future, I hereby give my consent in perpetuity to the International Society for Research in Human Milk and Lactation, and their affiliates and agents to utilize my image, likeness and sound of my voice as recorded on audio or video tape.  I understand that my image may be edited, copied, exhibited, published, or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording.   

I give permission to publish my name, in whole or in part, in publications, reports, promotional and/or educational materials and other media, including print, radio, television, and/or electronic formats, on the Internet or otherwise.    

There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.

By signing this form, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes.

By typing your name below, you agree to the above.

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