Release Form

Authorization to Reproduce Physical Likeness

I hereby expressly grant Regent University the right in perpetuity throughout the world to use a still photograph or video of my image for promoting the University and its programs, and for the purposes of recruiting, development and public relations. I also allow Regent University the right to use my comments and feedback for the purposes of testimonial advertising or other content pertaining to the marketing of or recruitment for Regent University.

I understand that my likeness may be used in any mediums now known or hereafter invented, including without limitation printed materials such as brochures, prospectuses, advertisements, flyers, etc. It also may be used on television, social media, in a video, or on the University website, or otherwise as the University shall determine.

 

Name

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Phone numbers

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Please select your Regent University School

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Please enter your Regent affiliation

Please enter your year of graduation

Please enter the date of the photo

AGREEMENT: By signing this Electronic Signature Acknowledgement Form, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.

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Date
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