Media Release Consent Form

MEDIA RELEASE AND CONSENT FORM

I, ________________________________________, hereby grant permission to XII SIGNS MAGAZINE, its editors, publishers, affiliates, and licensees, to use my name, image, likeness, voice, and/or statements in connection with photographs, interviews, video, or other media recorded for publish.

I understand that this material may be used in print editions, digital editions, websites, social media platforms, promotional materials, and archives of the magazine, worldwide, and for an unlimited duration, unless otherwise stated.

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Date: __________________________________________

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