PERMISSION TO USE PHOTOGRAPH(S)

I consent to allow Karen Kerkhoff Gromada, MSN, RN, IBCLC to use one or more
photographs showing myself, including areas of my exposed breast(s),  and my
infant(s) in the process of breastfeeding, I understand that the photographs
will be used for educational purposes, possibly including continuing education
presentations, journal articles, a professional web site, book chapters, etc. I
understand that my surname and that of my infant(s) will remain confidential
if any information or photographs are shared in any format with other health
care providers.

Signature:

Date:

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