Website release & consent form 2022
Juniata Business and Industry, Inc.
I hereby give permission to Juniata Business and Industry, Inc. to use any electronic data supplied to Website , I hereby authorize the Juniata Business and Industry, Inc. to exhibit, distribute and publish in print, video, audio recorded productions, and on the World Wide Web this data for purposes of publicizing Juniata Business and Industry, Inc. programs or other lawful purpose without payment or any other consideration. By signing this document, I understand that the data will be used only for nonprofit/educational or marketing purposes.
The above-named organization will not release the data to any other nonprofit or commercial entity without seeking my permission.
Any proceeds from the sale of published or printed matter containing the materials will be used to support the mission of the above named organization. (if applicable)
The data will become the property of Juniata Business and Industry, Inc., stored in a place chosen by Juniata Business and Industry, Inc. and will not be returned to me. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. I hereby hold harmless and release and forever discharge the Juniata Business and Industry, Inc. from all claims, demands, liability 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.
This authorization is continuous and may only be withdrawn by my specific rescission of this authorization. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.
Signature Date _______________________ Printed Name ____________________________
Address _____________________________________________________________________
City, State & Zip _______________________________________________________
Phone number Alt Phone _________________________________________________
Signature of Collector Date On behalf of the above named organization
_____________________________________________
I hereby give permission to Juniata Business and Industry, Inc. to use any electronic data supplied to Website , I hereby authorize the Juniata Business and Industry, Inc. to exhibit, distribute and publish in print, video, audio recorded productions, and on the World Wide Web this data for purposes of publicizing Juniata Business and Industry, Inc. programs or other lawful purpose without payment or any other consideration. By signing this document, I understand that the data will be used only for nonprofit/educational or marketing purposes.
The above-named organization will not release the data to any other nonprofit or commercial entity without seeking my permission.
Any proceeds from the sale of published or printed matter containing the materials will be used to support the mission of the above named organization. (if applicable)
The data will become the property of Juniata Business and Industry, Inc., stored in a place chosen by Juniata Business and Industry, Inc. and will not be returned to me. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. I hereby hold harmless and release and forever discharge the Juniata Business and Industry, Inc. from all claims, demands, liability 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.
This authorization is continuous and may only be withdrawn by my specific rescission of this authorization. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.
Signature Date _______________________ Printed Name ____________________________
Address _____________________________________________________________________
City, State & Zip _______________________________________________________
Phone number Alt Phone _________________________________________________
Signature of Collector Date On behalf of the above named organization
_____________________________________________