Client media release Progressive Life Center, Inc. Client Media Release Form Consent Yes, I do consent No, I do not consent I hereby grant to Progressive Life Center, Inc. (PLC), its representatives and employees the right to take photographs or video of me and of my property in connection with events conducted, sponsored or engaged in by PLC which I attend. I authorize PLC, its assigns and transferees to share with the funding source, copyright, use and the right to publish the same in print and/or electronically. I agree that PLC may use such photographs of me with or without my name and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, and Web content. In exchange for the opportunity to participate in the program, community activities, and related publicity endeavors of PLC, I hereby agree to release and hold harmless PLC, and their agents, assigns, and employees from any and all claims, demands, causes of action, and/or liability of whatever kind or nature arising out of or connects to the use of said voice/audio recordings, photos, videos, and quotations. Additionally, I waive any rights to royalties or other compensation for myself, the participant, or our successors, heirs, or assigns, arising or related to the production or use of the aforementioned materials. I understand my authorization will remain on file, effective from this date of my signature until the end of my employment, THE PRECEDING WOULD ONLY WORK FOR EMPLOYEES. OTHERWISE I’D DELETE IT. unless otherwise withdrawn by written notification.Name(Required) First Last Program(Required) PLC Office Location(Required) City/State(Required) Event Name(Required) (Thumbs Up!) Picture of ClientAccepted file types: jpg, jpeg, png, gif.Consent By selecting the checkbox and clicking Submit, I acknowledge that I have received and reviewed the preceding record and agree that my name shall be affixed to this record and constitute my electronic signature, to the same extent as if I had used my written signature.