Communications Release Form

I hereby grant permission to the rights of my image / testimonial / likeness / sound of my voice as recorded on audio or video, without payment or consideration.  I understand my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness or testimonial appears.  Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording.  I also understand that this material may be used in diverse educational settings within an unrestricted geographic area.
Photographic, audio or video recordings may be used for the following purposes:
  • conference presentations
  • educational or informational presentations or courses
  • online webinars and courses
  • educational videos
  • website 
  • social media posts
By signing this Release Form, I understand this permission signifies that photographic, audio or video recordings of me may be electronically displayed via the Internet or in a public educational or informational setting.
I will be consulted about the use of the photographs, audio or video recordings for any other purposes other than those listed above.
There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.
This release applies to photographic, audio or video recordings collected as noted on this document only.
By signing this Release Form, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby.  I hereby release any and all claims against any person or organization utilizing this material for informational or educational purposes.
If this release is obtained from an individual under the age of 19, then the signature of that individual's parent or legal guardian is also required.