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CPNRI Media Release Form

I hereby authorize the Community Provider Network of Rhode Island (CPNRI) to use, edit, copy, exhibit and distribute any video(s), photo(s) or any other form of media for any lawful purpose.

The authorization I provide herein extends to all languages, formats and media that have been discovered now or will later be discovered.

I acknowledge that the terms of this authorization is indefinite and will be active unless I revoke it in writing. I acknowledge that revoking these terms will not eliminate CPNRI's right to already published media and only revokes rights to future use.


I hereby waive all and any rights to all royalties or any other compensation in any form when it comes to the use of the video(s), photos or any other form of media.

I consent that the materials will be the sole property of authorize Community Provider

Network of Rhode Island (CPNRI).

CPNRI Media Release
Are you flling this form out for yourself?

We have received your release. Thank you!

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