I affirm that I am the person who created the attached photographic image and that I have full rights to the
content of the photograph. I give consent to release the name and photograph into the public domain. The
name and photograph may be used by Assemblymember Tom Daly for distribution, but will not be used for
DEADLINE: A completed entry form and photograph must be submitted by 5:00pm on Friday, March 24, 2017.
For more information, please contact Nadia Villafana at (714) 939-8469.