Brooklyn Letters

Video Testimonial Release Form


Video Testimonial Release Form

Date:

Authorization and Release Information

I understand my testimonial in the video recorded of me (the “Testimonial”) and made on behalf of Brooklyn Letters SLP PLLC (hereinafter called “The Business”) may be used in connection with publicizing and promoting The Business. I authorize The Business to use my first name and the Testimonial as defined on this form or by me in this video.

I hereby irrevocably authorize The Business to copy, exhibit, publish or distribute the Testimonial for purposes of publicizing The Business’ programs or for any other lawful purpose. These statements may be used in printed publications, multimedia presentations, on websites or in any other distribution media. I agree that I will make no monetary or other claim against The Business for the use of the statement.

I hereby hold harmless and release The Business from all claims, demands and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I have read the authorization and release information and give my consent for the use as indicated above.

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Signature Certificate
Document name: Video Testimonial Release Form
lock iconUnique Document ID: c27a1eb5a01a4a1dcff07f225133e5af634f40e6
Timestamp Audit
January 7, 2021 3:38 pm EDTVideo Testimonial Release Form Uploaded by Craig Selinger - nicole@brooklynletters.com IP 39.44.18.227