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FFRA MEMBERSHIP APPLICATION

Annual Dues

Contact Information

Developmentally Disabled Adult (DDA) Information

DDA Birthday (For Birthday Celebrations)
Month
Day
Year
DDA Special Considerations

Photo, Video, Social Media, Film Release

I hereby grant my authorized consent for the previously listed member(s) (DDA) to be recorded, photographed, videotaped, interviewed, and/or filmed by a representative of the FFRA for purposes of publication, display or broadcast (print, web, digital display and all other forms of media).


I agree that all recordings, articles, quotes, photographs, films, social media, audio, video and/or reproductions of the same in any form, are the property of the FFRA and I relinquish any present or future claim for reimbursement for said media of the member's likeness.


I hereby release the FFRA, its affiliates, employees, representatives, and agents from any ald all claims, demands, costs, liability that may arise from the use of these recordings, photographs, videos, audio, films, social media, print web, interviews, and/or digital display of any and all other forms of media.


I acknowledge that I have read this consent form in its entirety, or it has been read (translated) for me, and I have had the opportunity to ask questions about it and understand it.

Consent to photograph, video, record, film, use on social media, and any other forms of media
Yes
No

All members receive general correspondence about FFRA events, including the monthly event schedule and newsletter. All members are invited to attend scheduled events and Board of Director's meetings. Members may view the FFRA bylaws at www.ffracitrus.org/bylaws.

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