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Upload your headshot or selfie below; or email directly to email@example.com
I hereby grant to Surry County the irrevocable and unrestricted right to use and publish photographs of my likeness, or in which I may be included, for any publications, electronic reproductions (web sites, social media) and/or promotional materials or any other purpose and in any manner or medium. In addition, I grant my permission to alter the same without restriction; and to copyright the same. I hereby release Surry County from all claims and liability relating to said photographs.
Enter name here signifying acceptance of the Photography Release Statement.
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