Farm Bureau Photography Request Form Farm Bureau MASH Photography Interest Form Date(Required) MM slash DD slash YYYY Community Director's Name(Required) First Last Community Director's Email(Required) Select the type of camp you are requesting photography for:(Required)Please select one of the following:MASH: Full 2-Week Summer CampMASH: Mini MASH 1-Week Summer CampCHAMPS: 3-5 Day Summer CampCamp Name(Required) Camp Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Camp Start Date(Required) MM slash DD slash YYYY Date you are requesting photography for:(Required) MM slash DD slash YYYY Have all photography/press release forms been received from student participants?(Required) Yes No If no, please specify reason below. Note: It is the camp director's responsibility to notify photographers and UAMS MASH administrative staff to ensure that if a participant does not consent to photographs, their privacy is maintained.(Required)Additional information for photographer: specific activity you would like to capture (i.e. suturing demonstration, cpr certification, etc.), specific location and time this activity will take place., and any other information that would be helpful to the photographer.