Image Release

ABN65 055234508
Reg.No.A000 4054F
Image Permission & Release Form

For Ballarat Camera Club INC. Members
Thank you for submitting your image for use by the Ballarat Camera Club (BCC) This form is to verify that you
have given BCC permission to use your image in the manner described herein. You will retain full copyright of
your image and may continue to use the image in any manner you see fit. In view of your rights under
Australian Copyright laws, please check one or more of the following options and sign below:
Tick to Approve External Use of Image/s

By ticking this option and signing below, you certify that you have granted BCC permission to use the image/s described, on a rights managed basis, and to authorize third party use of the image/s on a rights
managed basis as prescribed, in writing, by BCC.
Tick to Approve Internal Use Only of Image/s
By ticking this option and signing below, you certify that you have granted BCC permission to use your
image/s for internal use only, for BCC presentations, publications and materialsboth print and electronicbut may not be reproduced by others without the written permission of the owner. However, because
our website is publicly accessible, these images will be down loadable. BCC will only use limited
resolution versions of your images.
Tick to Approve External Press Material Use Only
By ticking this option and signing below, you certify that you have granted BCC permission to use your
image/s for releases, news tips, and other distributed newsroom materialsboth print and electronic
only. However, because websites are publicly accessible, these images will be down loadable. BCC will
only supply limited-resolution versions of your images for electronic use.
I,
.
(Print name)
Understand and agree to the terms of this form where I have indicated. Strike out sections not required.
SignatureDate
Image/s details: You only need to include image details if you ticked the first section above.
BCC strives to provide as much accurate information as possible about each image. On the back of this page,
please provide the information requested, including a caption and credit, and any additional information such
as the date of the image. If there are any restrictions on the use of this image that you would like to accompany it, please include these as well.
Copyright ,Ballarat Camera Club, INC
Image/s Details - Please print an additional page if you have more than five images.
CAPTION/s
Image No: (
).............................................................................................................................................
Image No: (
).............................................................................................................................................
Image No: (
).............................................................................................................................................
Image No: (
).............................................................................................................................................
Image No: (
).............................................................................................................................................
CREDIT (Write exactly how you would like the credit line to read if required):
Image No: (
).............................................................................................................................................
Image No: (
).............................................................................................................................................
Image No: (
).............................................................................................................................................
Image No: (
).............................................................................................................................................
Image No: (
).............................................................................................................................................
DATE OF IMAGE/s
Image No: (
).............................................................................................................................................
Image No: (
).............................................................................................................................................
Image No: (
).............................................................................................................................................
Image No: (
).............................................................................................................................................
Image No: (
).............................................................................................................................................
RESTRICTIONS FOR USE: (PLEASE NOTE: If there are additional restrictions to use this image/s, BCC will
be mindful of the information.
Copyright ,Ballarat Camera Club, INC

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ABN65 055234508

Image Permission & Release Form

Tick to Approve External Use of Image/s

Copyright ,Ballarat Camera Club, INC

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