Permission to publish Personal Information/Photographs

Please return a signed copy to the Gryphon's Lair Webminister: Lord Brynjólfr Álarrsson.

I, (Legal Name) _____________________________________, known in the Society for Creative Anachronism as

______________________________________, do hereby give permission for the Barony of Gryphon's Lair in the

Kingdom of Artemisia to publish on its Webpages the following contact information:

You do NOT have to fill in all the information, only that which you wish to have published online:

Legal Name:        YES / NO (please circle one)
SCA Name:         YES / NO (please circle one)
Mailing Address:  YES / NO (please circle one)
Phone Number:    YES / NO (please circle one)
E-mail address:    YES / NO (please circle one)

Mailing Address:___________________________________________

___________________________________________________________

___________________________________________________________

Telephone #: (_____) ______________________________________

E-mail Address:____________________________________________

___________________________________________________________

Title (if any): ___________________________________________

I also grant the Barony of Gryphon's Lair of the Kingdom of Artemisia permission to publish on its web pages

any images in which I may appear that were taken or made during SCA activities, with the conditions noted below.

I understand that the image/s will be used in accordance with SCA standards of chivalry, style and taste in a

manner that portrays myself and the Society in a positive light.

(check one please):
0 All images from SCA activities can be published without my specific review
0 All images from SCA activities can be published, provided my group's Chronicler has been consulted
0 Only images I approve on a case-by-case basis can be published.
0 Do not publish any images whatsoever.
This permission is good until revoked by me in writing or for one year, whichever is less.

Legal Signature: __________________________________________

Date: _____/_______/_____

Gryphon's Lair Web Minister's Office Form 01/Version 3.0 / Last Revised 12/07/07