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2. First Name

3. Last Name

5. Address1

7. Address2

9. City

10. State

11. Zip

13. Email Address

15. Describe the photos you are submitting

17. Release
    I hereby grant permission to the City of Bristol to use the attached photos for use on the City of Bristol, Connecticut website. This authorization is continuous and may only be withdrawn by my specific rescission of this authorization.

    I hereby grant permission to the City of Bristol to use the attached photos for use on the City of Bristol, Connecticut website. This authorization is continuous and may only be withdrawn by my specific rescission of this authorization.

19. Upload Photos

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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

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