Photo Consent Form

I grant permission to the Leadership Training Institute of America, inc. to use images of
(Your Name) (required) .
Such use includes the display, distributions, publications, transmissions or otherwise use of
photographs, images and/or videos taken for use in materials that include, but may not be
limited to, printed materials such as Brochures, Newsletters, Videos and digital images used
on LTIA's Website and Social Media Pages, such as Facebook and for LTIA's Fundraising
Events.

I grant permission for the use of photos of myself to be used.I deny permission for the use of photos of myself to be used.

Your Email (required)

Please make a copy of this form for your own records.
Please notify Leadership Training Institute of America, Inc in writing if you would like to withdraw your permission for the use of images.