AFSCME Council 65 Media Release Form


I hereby authorize the American Federation of State, County and Municipal Employees (AFSCME), and its affiliate AFSCME Council 65, to use my name, photo, video, audio, signature, or quotes in communications including but not limited to: direct mail, leaflets, website content, print or electronic media advertising, press releases.

Contact Information

Please share your contact information with us so we can accurately attribute the photo/video and so we can reach out with any questions we may have.

Please let us know any official roles you have within your local or Council 65. (President, Treasurer, Steward, Staff, etc...)
Image/Video/Media Details:

Let us know a little bit more about the media.

If you have not already shared the photograph, video or other media with us, please attach it here. If you have issues please email the media to [email protected]. Make sure to click "upload" button after choosing file. Formats Accepted: jpg, gif, png, txt, pdf, doc, docx, ppt, pptx, avi, mov, wav, mp3, mp4, rar, zip.
Files must be less than 100 MB.
Allowed file types: gif jpg jpeg png txt pdf doc docx ppt pptx avi mov mp3 wav rar zip mp4.
Please list any other people who appear clearly in the photo/video. Provide any relevant information about them we should include with use of this media.
If you have a quote you would like to give related to the media, please write it here.
Please add any other information you would like us to know about your media.
Authorization:

I hereby authorize the American Federation of State, County and Municipal Employees (AFSCME), and its affiliate AFSCME Council 65, to use my name, photo, video, audio, signature, or quotes in communications including but not limited to: direct mail, leaflets, website content, print or electronic media advertising, press releases.

If using a tablet, smartphone, or touch screen, please sign with finger. If using a personal computer please sign using mouse curser.