Amy Biehl Youth Spirit Award Nominee Photo Release

To be completed by nominee only.

I hereby grant New Mexico Voices for Children (NM Voices) permission to use my likeness, voice, picture and name for print, radio, television broadcast and electronic media, including NM Voices’ website, anywhere throughout the United States and the world and to edit such material on film, audiotape or videotape for the purpose of promoting NM Voices, the Spirit of Hope Celebration, and the Amy Biehl Youth Spirit Award.

I hereby attest that I have read and agree to the above statement on

Today's Date (mm/dd/yyyy)

Signature (Full name spelled exactly how you want it to appear in the program!)

**Note: entering your full name in this box serves as your signature and agreement to the above statement.

Your Address



Zip Code

Phone (xxx-xxx-xxxx)