Name *

First Name

Last Name

Phone number

(###)

###

####

Usage Permissions *

I grant permission for my photo/video to be used in the following ways: Social Media (Facebook, Instagram, Twitter, LinkedIn, TikTok, etc.) Website & Blog Content Print Marketing Materials (Brochures, Flyers, Posters) Digital & Traditional Advertising Promotional Videos & Presentations I understand and agree to the following: * I grant full rights to use my image/video without payment or consideration * The media may be edited, copied, exhibited, published, or distributed * I waive any right to inspect or approve the finished product * I waive any right to royalties or compensation arising from use of the media * I release the company from any claims that may arise regarding the use of the media * This authorization is valid indefinitely unless I revoke it in writing By checking this box I confirm that I have read and agree to the terms outlined in this consent form

Agree