Tle General Authorization Form

Excellence in Literacy

AUTHORIZATION FORM General Release: Photograph/Video/Voice

I _______________________________________________ (please print name) hereby authorize The Learning Exchange to use my photograph, video or voice recording for purposes related to the mission of The Learning Exchange, including publicity, marketing and promotion of TLE and its programs/services.

I certify that I have read and understand the above statement and I consent to the use of my photograph, video or voice recording for the purpose/s stated.

Darlene Brown Name

Executive Director’s name

Signature

Executive Director’s signature

Date

Date

w w w. TL E lit e r a cy. co m

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