Media Opt-Out Form I do not authorize Project: Time Off, a wholly

Media Opt-Out Form
I do not authorize Project: Time Off, a wholly-owned initiative of the U.S. Travel Association
(“U.S. Travel”), to use personally identifiable recordings or photographs of myself made by U.S.
Travel and its agents during or in connection with my attendance at the Upside of Downtime
Forum. I have provided a picture of myself to be used as reference to assure my dis-inclusion in
any images used by U.S. Travel. I will notify photographers in my vicinity that I do not wish to
be photographed. In signing this Form, I understand that U.S. Travel will make reasonable
efforts to avoid access to, or remove, my image or voice for all purposes identified herein.
Adult (Over 18)
Date: _________________ Name: __________________________________________
Address: ____________________________ City: ______________________________
State: ___________ Zip: ____________ Phone: ___________________
Email: _____________________________________________
I confirm that I have read and agree to the terms of the above “Media Opt-Out Form.”
Signature: _____________________________________________
Child (Under 18)
Date: ____________________ Child’s name: ________________________________
Parent’s Name: __________________________________
Phone: ______________________ Email: ___________________________
I confirm that I am the Parent or Guardian of the child listed above and I affirm that I
have read and agree to the terms of the above “Media Opt-Out Form”.
Signature: _____________________________________________
Return this form including a reference photo to the Upside of Downtime Forum
Registration Desk. Form must be countersigned at desk to be effective.
Form and Photo Received by: ________________________
Date: ______________________________
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