Professional Documents
Culture Documents
)HEUXDU\ 2015
Tama Hills Recreation Center
MILITARY MEMBER INFORMATION: (Please print legibly)
LAST NAME
FIRST NAME
MI
Birth Date
Age
Gender
M
Branch of Service
F
Years of Service
RANK/RATE
Permanent Command
Work Phone
Home Phone
Cell Phone
E-Mail Address
For Meal
Vegetarian only
I hereby grant permission to the rights of my image, likeness, and sound of my voice as recorded on audio or
video tape without payment or any other consideration. I hereby waive the right to inspect or approve the
finished product wherein my likeness appears. I also understand that this material may be used in diverse
noncommercial, nonprofit settings within an unrestricted geographic area.
(Participant's signature) ___________________________________
Command
E-mail Distribution
CREDO Staff
Family/Friend
Other_____________________
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Date:
Date:
SIGNATURE:
DATE:
Rank
Supervisor e-mail
I acknowledge that the member above is planning on attending a Personal 5HVLOLHQF\ Retreat and
I
APPROVE /
DISAPPROVE his/her attendance.
Supervisor
SIGNATURE:
DATE: