NOTE: Fields highlighted in YELLOW are required. Photographer Information FIRST NAME * LAST NAME * ADDRESS* PHONE* * CITY STATE AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP EMAIL* * Photo Details UPLOAD PHOTO * Files must be less than 20 MB.Allowed file types: gif jpg jpeg png. LOCATION PHOTO TAKEN * YEAR PHOTO TAKEN DESCRIPTION (ex. Enjoying the festivities at Irvine Global Village, Hiking in Bommer Canyon) Agreement IN ORDER TO UPLOAD YOUR PHOTO, YOU MUST AGREE TO ALL OF THE FOLLOWING: I ATTEST THAT I AM AT LEAST 18 YEARS OF AGE OR OLDER. I ACKNOWLEDGE THAT IF THERE ARE PEOPLE WHO ARE EASILY RECOGNIZABLE IN MY PHOTO, I HAVE THEIR PERMISSION TO SUBMIT THEIR IMAGE FOR USE BY THE CITY. I HEREBY IRREVOCABLY CONSENT TO AND AUTHORIZE THE USE AND REPRODUCTION BY THE CITY OF IRVINE, OR ANYONE AUTHORIZED BY THE CITY OF IRVINE, OF ANY AND ALL PHOTOGRAPHS. THESE PHOTOGRAPHS MAY BE USED FOR ANY PURPOSE WHATSOEVER, WITHOUT COMPENSATION. Agreement Signature * I AGREE TO ALL OF THE ABOVE. Date Agreed The City of Irvine takes your privacy seriously. This form asks you to provide the City with certain personal information. Such information is being requested and will be utilized by the City for the specific and limited purpose of future City correspondence regarding the subject-matter of this form. Pursuant to Measure S, an initiative ordinance passed by City voters in 2008, the personal information noted by an asterisk (*) on this form will be kept confidential. Unless you expressly indicate to us otherwise or unless compelled by a court order, it will not be shared with other agencies, businesses or individuals. Math question * 14 + 1 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
