If applicable, Leadership Brevard or Leadership Essentials graduation year *
I Signature* give LEAD Brevard, the absolute right and unrestricted permission to take, use my name, testimonial, and biographical data and/or publish, reproduce, edit, exhibit, project, display, and/or copyright photographic images, pictures, video, or recordings of me through any form of media (print, digital, electronic, broadcast or otherwise) for art, advertising, recruitment, marketing, fundraising, publicity, archival or any other lawful purpose.I waive any right that I may have to inspect and approve the finished product that may be used or to which it may be applied now and/or in the future, whether that use is known to me.I understand that virtual programming may be recorded and grant permission for LEAD Brevard and/or any person(s) or entities authorized on LEAD Brevard’s behalf to record tape, film, photograph, edit, alter, digitize, or otherwise capture and preserve in permanent from my name, likeness, biographical material, voice, and/or performance/display. I further grant permission for LEAD Brevard or any person or entity authorized by it, to broadcast, publish, or transmit all or any portion of the recording or altered/edited recording in any form, via any means.
First Name* Last Name* Date*