Authorization and Release for Publication of Information

By submitting this form, the individual hereby grants permission to the Southern Maryland Volunteer Firemen's Association (SMVFA) to publish, reproduce, and use the submitted information in the SMVFA Memorial Service Program. This authorization includes the right for SMVFA to disclose, display, and distribute the information in any and all program materials associated with the memorial service. The individual acknowledges and agrees that this release is binding and irrevocable.