Photo/Video Consent and Release Form

  • This standard consent and release form relates to photo/video/audio (Recordings) at workshops and masterclasses held by Concentric Strategies Inc. t/a Michel Neray, Essential Message or momondays, (Organizer). I hereby give my consent to the Organizer, its affiliates and agents, to use my Recordings, image and likeness and/or any interview statements from me in its publications, advertising or other media activities (including the Internet). This consent includes, but is not limited to:

    (a) Permission to interview, film, photograph, tape, or otherwise make a video reproduction of me and/or record my voice;

    (b) Permission to use my name; and

    (c) Permission to use quotes from the interview(s) (or excerpts of such quotes), the film, photograph(s), tape(s) or reproduction(s) of me, and/or recording of my voice, in part or in whole, in its publications, in newspapers, magazines and other print media, on television, radio and electronic media (including the Internet), in theatrical media and/or in mailings for education and awareness.

    This consent is given in perpetuity, and does not require prior approval by me.

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