Media Authorization Usage

Organization Name* , (“the Organization”) by and through its undersigned authorized representative, hereby gives permission for Wellness Grove to publish and/or use its organization logo or registered mark for all purposes connected with the business of Wellness Grove. It is understood that Wellness Grove may use said logo or mark for advertising relating to Wellness Grove, the WellnessGrove.com website, the Wellness Grove app, partner websites, and all other purposes related to Wellness Grove and its mission. Wellness Grove may use the Organization’s logo or mark for these purposes without further permission or acquiescence by the Organization, and the Organization hereby releases Wellness Grove from all liability relating to the publication or use of the logo/mark.

The Organization understands that Wellness Grove shall not knowingly or intentionally alter the logos or registered mark, or manipulate any image(s) thereof, either by blurring, distortion or other means of reproduction or display. Organization further understands that Wellness Grove will not take any action that would tend to diminish the goodwill of the logos/registered marks or bring the logos/registered marks or Organization into public disrepute.
Initial Page*
Short Description of Services
Organization Website URL

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By signing this form electronically and clicking on "Sign & Submit", you are certifying that you are agreeing to the terms and conditions provided herein. Please note that an e-signature is the electronic equivalent of a hand-written (pen-and-paper) signature.*

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Authorized Representative Name*
Date*

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