Personal Information Release Form
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  I hereby grant my consent to use and license the use of my name, my likeness, and my personal information whether in still or in motion pictures, my photograph and/or other reproduction, including my voice and features, with or without my name, for any editorial, promotion, trade, webpage, business or other purpose whatsoever, or for testimonial and endorsement or product advertising. Carlow University may exercise its rights in any way it sees fit for its production, for advertising, for the web, and for other purposes.
     
     
  _______________________________________
    Signature
     
  _______________________________________
    Name (Printed)
     
  _______________________________________
   
  _______________________________________
    Address
     
     
  (_____)_________________________________
    Telephone number
     
    Witnessed by:__________________________________ Date: __________________________