National College of Midwifery SIS and LMS Portal.Powered By Classe365

Media Release Form

This form is to submit photos you are releasing for NCM college and midwifery promotion use.

Step 1

First Name^*

This is the name of the person filling out this form.

Last Name^*

This is the name of the person filling out this form.

NCM Email^*

List the Name of Every Person in this Photo^*

Every person in this picture must fill out a media release.

List the Name and Email of Every Person in this Photo^*

NCM will contact these people to obtain a media release. If there are no other people in the photo other than yourself please type N/A.

Photo You Are Provide this Media Release For.^*

I give the National College of Midwifery permission to use the photo I uploaded to this form service to midwifery and midwifery education promotional materials, including but not limited to the National College of Midwifery website, social media sites, brochures or other printed media. I agree to transfer all rights of the image to the National College of Midwifery.

I understand that I will not receive compensation in any form.

Clicking the submit button will constitute your electronic signature and certifies that all information is true and correct to the best of your knowledge.

Please accept the terms & conditions to submit this form.

Media Release Form

Step 1

Upload Image