Photo Consent Form

Name

Address

Phone Number

E-mail

Consent

I grant permission to the NOTL Ambassador Program for the use of the photograph(s), electronic media images, or videos of me or in which I may be included as identified in any promotional materials, presentations, social media or internal material of any and all kind whatsoever, as long as they are used to promote NOTL Ambassador initiatives. I understand that I may revoke this authorization at any time by notifying info@notl-ambassadors.ca in writing. The revocation will not affect any actions taken before the receipt of this written notification.

I DO NOT consent

Your Signature

Date

Attestation

I attest that I personally and freely signed this document

Submit

Photo Consent

A form is provided below for submission of photo consent by NOTL Ambassadors