I, , hereby authorize to release my full name and contact information to Nueva Esperanza, Inc. (NEI), Esperanza Immigration Legal Services (EILS), Esperanza USA, Esperanza Academy Charter School, and/or Esperanza College, their subsidiaries, affiliates, licensees, successors, and assigns, (collectively referred to as “Esperanza”) and further authorize Esperanza to use my full name and contact information in connection with education, outreach, public relations, fundraising and marketing, related to or on behalf of Esperanza.
I acknowledge that I will not receive any future compensation for the uses related to the data collection and hereby release Esperanza and its agents and assigns from any and all claims which arise out of or are in any connected with such use.
I hereby hold harmless Esperanza and those acting on their behalf for the collection and use of data obtained for fundraising, marketing, education, outreach and public relations related to or on behalf of Esperanza, including any rights of privacy or publicity.
This form has been fully explained to me in English and/or my native language and I certify that I understand its contents.
I swear under penalty of perjury under the law of the United States that the foregoing is true and correct to the best of my knowledge, this day