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.

Regent shall own all right, title and interest (including the copyright) in all materials produced by or for it. Any further use of the materials, including without limitation my likeness, shall require the prior written consent of Regent.

Name *

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Phone numbers

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Regent University School

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Please enter your email Please enter your email address in the correct format.

Regent Affiliation

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Year of Graduation

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Date of Photo

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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.

Please type your First and Last Name

Please type your full name

Date

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I understand that checking this box constitutes a legal signature confirming that I acknowledge and warrant the use of my image in Regent University marketing material.