The Free Clinic of Central Virginia would like to use your photographs for promotional purposes. These images may be sent out in the media, social pages, used for publications or on our website.

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I agree to allow the Free Clinic of Central Virginia to take photographs of me and grant permission for these to be used by the Free Clinic and its project partners to promote the Free Clinic including, but not limited to publications, articles, promotional materials, or websites. I also agree to the use of my name in the ways listed above.