BETTER BUSISNESS BUREAU
Media Disclosure and Consent Form
I hereby voluntarily and irrevocably grant to the Better Business Bureau (BBB) system (including all BBB’s in North America, the Council of Better Business Bureaus, Inc., and the Canadian Council of Better Business Bureaus, Inc.) permission to use the photograph I have submitted, and to reproduce, use and publish my image, with or without my name, title and name of business in perpetuity for all purposes in all forms and media throughout the world.
I understand that I will not inspect or approve versions of my image used for publication or the written copy that may be used in connection with my image.
I also release the BBB system from any and all claims that arise from the reproduction, use and publication of my image.
Name: ______________________________
Title: _______________________________
Signature: ____________________________
Business Name: _________________________________
Address:________________________________________
City: ______________________ State: _________ Zip: ___________
Phone: _____________________
Person in Photo: ________________________________
Title:____________________________________
Signature of Person in Photo: ____________________________
Date: ___________________________