By completing this form, I irrevocably authorize Revitalize Project, Inc. to copy, duplicate, exhibit, publish, alter, distribute or otherwise use my name, words, or likeness (my “Testimony”) in any promotional materials, including, but not limited to, electronic and print media. Revitalize Project, Inc. shall have complete ownership of the Testimony, any related materials and derivative products. I further agree that I possess no ownership rights, including but not limited to copyright, to any promotional materials or finished product.

Any photos or video will become the property of Revitalize Project, Inc. unless otherwise specified. I acknowledge and agree that I shall have no right to inspect or approve the finished product, wherein my Testimony appears, now or in the future and agree to make no monetary or other claim arising out of the use, alteration, or distortion of such materials. Furthermore, Revitalize Project, Inc. has no obligation to use my Testimony as part of its promotional material or media products.

I hereby hold harmless and release Revitalize Project, Inc. from all demands 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. I have read the authorization and release information above and give my consent for the use as indicated above.