We Are Medway

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* 1. Name as you would like shown

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* 2. Occupation:

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* 3. Age? Note, goal would be to add age to posting, but not mandatory - if you rather not posted please leave blank.

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* 4. Choose All That Apply

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* 5. If Resident, Resident since what year?

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* 6. If Medway business owner, town employee or volunteer (past or present) how long? years? position held, etc.?

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* 7. Please describe in a few sentences, something about you to accompany the photo you might want to share (not answered already). i.e. What Medway means to you?

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* 8. I hereby grant Tim Rice, dba Tim Rice Photo permission to use the photographs taken of me, in relation to the WE ARE MEDWAY PROJECT on the date identified below. 

I understand and agree these photographs will become the property of Tim Rice, dba Tim Rice Photo and will not be returned. 

I acknowledge that since my participation with Tim Rice, dba Tim Rice Photo and the WE ARE MEDWAY PROJECT is voluntary, I, nor my heirs, will receive no financial compensation or royalties in relation to these photographs mentioned.

I authorize Tim Rice, dba Tim Rice Photo to edit, alter, copy, exhibit, publish or distribute this photo for purpose of publicizing the TIM RICE PHOTO - WE ARE MEDWAY PROJECT in a lawful manner.

Filling in name, town, state, and email address will act as a signature.

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