In consideration of our mutual desire to help educate the public about the dangers of impaired driving. I hereby authorize MADD - Mothers Against Drunk Driving National Office, State Office, Local Chapter, and MADD Partnership agencies to use the photo of the victim that I am submitting at this time, in a brochure/publication/photo board/billboard/media campaign - to better educate the public about the dangers of impaired driving.
I understand that the photo will be used by MADD for an unspecified period of time. MADD will not provide any monetary compensation for any materials used. I also represent that I have the legal authority to give this authorization.
Please check below which areas of publication you DO NOTwant to give consent for: