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7. What is your contact information?
9. First Name*
10. Last Name*
12. Address*
14. City/Town*
15. State
16. Zip Code
18. Email Address*
19. Phone Number
21. Are you age 18 or older?*

    1. Yes
    2. No
22. If you are under the age of 18, do you have permission from a parent or guardian to submit this image?

    1. Yes
    2. No
24. If you did not create this image yourself, please include the name of and contact information for the person who did (including your relationship to them) here:
26. If you are not a resident, what is your connection to Bedford?
28. If the image you submit is published, how should the Town attribute the photo?*

    1. I would like the Town to use my full name (or the name of the individual who created the image) as provided above
    2. I would not like my name used and permit the Town to credit the image as submitted anonymously
30. Please upload your image here*
    The Town requests that only images created during the past two years are submitted.
    
    

    Please only submit high quality images preferably in a .jpeg or .png format.

32. If you would like to provide a title for your image, please do so here:
33. What was the approximate date on which the image was created?
    What was the approximate date on which the image was created?
35. Please describe the photograph and what you were intending to capture:
37. Agreement*

    I understand that by submitting a photo, I confirm and agree that I am the sole copyright owner of the photo and that it does not infringe on any third-party rights. By submitting a photo, I grant the Town of Bedford a non-exclusive, irrevocable, royalty-free worldwide license to use, reproduce, publish, display, modify, adapt, and distribute the photo in any manner the Town deems fit including, but not limited to, official town reports and publications and for marketing or promotional purposes.

    
    Further, I confirm and agree that the photo does not depict any illegal activity or violate any laws and does not contain any offensive, obscene, defamatory, or hateful content. If the photo includes identifiable people, I confirm and agree that I have obtained permission from those individuals for their image to be used in this manner. I agree to indemnify and hold harmless the Town of Bedford from any claims or lawsuits arising from my photo submission.
    
    I understand that the Town of Bedford reserves the right to reject any photo that does not comply with these terms or which is deemed inappropriate at its sole discretion.

    1. Yes, I understand and agree to continue with this submission
    2. No, I do not agree to these terms
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44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field