Cultural Vistas, Inc.  a non-profit organization, produces marketing and public information materials in multiple formats for the purpose of highlighting and sharing the diverse experiences of our participants through our programs. Cultural Vistas seeks to build its Image Bank through the donation of images (still or moving) and other related content from its participants, partners, clients and stakeholders, including current participants and program alumni.

I hereby grant Cultural Vistas the right to use, reproduce, publish, and create derivative works of my submission, including any words, images (still or moving), sounds, and likeness in connection with related marketing and public information programs and activities. I also understand that Cultural Vistas has final say over the inspection or approval of the finished product or products or advertising or printed matter that include my imagery in connection with these materials or the use to which it may be applied. I recognize I have the right to revoke this permission at any time by submitting a revocation request to

Additionally, I hereby authorize Cultural Vistas to release, publish, or quote such material in connection with related marketing and public information programs and activities. With respect to this material, I understand that content may be included in various outlets, on the Internet, and through multiple broadcast channels and print media.

You may also use my name with my submission.

For current participants: I understand that I may decline to give my consent (by not signing this Form)
and still continue to participate in all exchange program activities without being disadvantaged with
respect to those activities.

This release is in governance with the laws of the State of NY. By signing, I certify that I am over 18 years of age and that I have read, fully understand and accept all terms of the foregoing statement.