Social Media Consent Form

I First Name   Last Name   hereby authorize LKN Drip, PLLC to use my photo and/or name related to my experience with LKN Drip, PLLC. I understand this information may be used in publications, including electronic publications, audiovisual presentations, promotional literature, advertising, community presentations, media and other similar ways. LKN Drip, PLLC will disclose to me or my legal representative, where appropriate, the specific information and/or photo to be used prior to release in the social media.

My consent is freely given as a public service to LKN Drip, PLLC without expecting payment. I release LKN Drip, PLLC and their respective employees, officers and agents from any and all liability which may arise from the use of such news, media stories, promotional materials, written articles, videotape and/or photographs.

I prefer that : 
 My complete name be used   My first name only be used   No name be used   

I understand that I can revoke this release at any time in writing and that the use of any of my photos or other information authorized by this release will immediately cease.
Signed consent form expires 1 year from completion