北美 彌陀村 Mituo Village Of North America 343 Conrad Road, Alburtis, PA 18011 影像使用同意書 MEDIA RELEASE AUTHORIZATION The pure land learning center, U.S.A. requests permission to reproduce, through audio or visual means, activities related student’s education. Your signature below will enable us to increase public awareness and promote continuation and improvement of educational program through mass media, displays, brochures, etc. The medial mentioned herein including but not limited to photographs, films, slides, internet, video, and audio tape recordings. GRANTING OF PERMISSION IS VOLUNTARY AND SHALL REMAIN IN EFFECT THROUGH THE ENTIRE CAMP ONLY. I hereby give my permission: ►________________________________ _______________________ _______________ (Parent or Legal Guardian’s Signature) (Relationship) (Date) 

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