I hereby give permission to Western Washington University to share my image and/or quote in its public information activities and to use the information I provide here with regard to related follow-up interviews, meetings or questionnaires. This could include use in WWU publications, web pages, social media, video and television. At the discretion of the Office of Communications and Marketing, use could also include making this information or my image available to non-university organizations that publish news about the university, such as newspapers, magazines, news broadcasters and other news organizations. Phone Number * E-mail * What is your affiliation with Western? * - Select -Freshman StudentSophomore StudentJunior StudentSenior StudentGrad StudentFaculty/StaffAlumniProgram ParticipantCommunity MemberOther... What is your affiliation with Western? Other... Type your full name. This acts as your signature and indicates that you agree to the terms listed above. * Today's Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year201720182019 Photographer/contact name * Event/photo description * Street address Image Permission Checkbox * I am emailing the Contact listed above an image I own and give Western permission to use said image in the manner outlined above.