MEDIARELEASE

*THIS IS ONLY FOR THOSE APPEARING IN BROADCASTS, WHERE ANY ASPECT OF YOUR LIKENESS ETC. MAY BE USED.

MEDIA RELEASE FORM

CHECK THAT YOU AGREE *

The person(s) named below freely and completely grants permission to Drs Aaron and Margaret Jamal, also known as and hereinafter known as the “I Do Me2 Media” to use my image (photographs and/or video) and voice for use in Media publications including: - Videos - Email Blasts - Recruiting Brochures - Newsletters - Magazines - General Publications - Website/Social Media and/or Affiliates and related projects

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Name *

First

Last

Name *

First

Last

CHECK THAT YOU AGREE *

I/ We hereby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image, voice and likeness.

Please CLICK the paragraph below which is applicable to your present situation:

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I am/We are 20 years of age or older and I am competent to contract in my own name. Ihave read this release before signifying my agreement by clicking AGREE, and I fully understand the contents, meaning and impact ofthis release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release. I am/We are the parent(s) or legal guardian(s) of the below named child. I have read this release before signifying my agreement by clicking AGREE, and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.

Child Name (If applicable) *

DIGITAL AGREEMENT *

I /WE AGREE WITH ALL TERMS IN THIS RELEASE

DIGITAL SIGNATURE
By clicking the agreement box, you indicate that you read and completely agree to the terms indicated in this Media Release

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