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The Voice of the

Commonwealth's Counties

VACo Electronic Signature Permission and Release Form

VACo Speaker Permission and Release Form

This is to confirm that the undersigned has agreed to participate in a program, publication or event sponsored by the Virginia Association of Counties (VACo). VACo may record programs and make those audio and video recordings, and/or transcriptions thereof, available to its members and others interested in the topics being covered. VACo also posts presentations on its website and may provide copies to interested parties. VACo is requesting your permission to record, edit, transcribe, duplicate and distribute your presentation in any and all media existing or hereafter developed.

I hereby grant the Virginia Association of Counties the right to include copies of my materials and presentation in handout, CD/ media, website or other format distribution. I understand that I retain all rights to the use, publication, and reproduction of this material. I further certify that all handout material is my own original work and/or that I have obtained/included written permission from the copyright holder to reproduce his/her copyrighted work.

I hereby consent to the use of my presentation and other materials as described in the provisions of this form: