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Modern States Education Alliance Model Consent Form

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¹ MODERN STATES EDUCATION ALLIANCE MODEL CONSENT FORM In connection with the Project referenced above, I irrevocably grant Modern States Education Alliance permission to: • Take video footage or photographs of me; • Use, reproduce, publicly display, distribute copies of any such video footage or photographs; and • Use my name, likeness and biographical information. By granting this permission, I release Modern States Education Alliance and its agent Amigot Corp – IBL its trustees, officers, employees and agents from any liability to me or my heirs based on the release of video footage or photographs of me. I fully understand the nature of this permission granted by me and I voluntarily consent to sign it. This release is governed in accordance with the laws of the State of New York.

Modern States Education Alliance Model Consent Form

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