Fill and Sign the Testimonial Release Form

Testimonial Release Form Client Consent Form for Release of Confidential Information I ,       hereby grant my permission to (Name of Client)       , hereinafter called the (Name of Organization) Organization, to publish and publicize the attached information and testimonial initialed by me about my experience as a client of the Organization and use of its product       , hereinafter called the Product. (Name) I understand that this information, including my name, will be used in media relations, advertising, marketing, and other communication strategies to internal and external audiences. Any materials produced will remain the property of the Organization. I also understand that my permission is limited to the attached information and does not represent broad authorization to publicize additional information about my experience with the Organization and its Product. I hereby hold harmless and Release and forever discharge Organization from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this Release. In addition, I waive any right to inspect or approve the finished product, including written copy, wherein my testimonial appears. Severability. The invalidity of any portion of this Release will not and shall not be deemed to affect the validity of any other provision. If any provision of this Release is held to be invalid, the parties agree that the remaining provisions shall be deemed to be in full force and effect as if they had been executed by both parties subsequent to the expungement of the invalid provision. No Waiver. The failure of either party to this Release to insist upon the performance of any of the terms and conditions of this Release, or the waiver of any breach of any of the terms and conditions of this Release, shall not be construed as subsequently waiving any such terms and conditions, but the same shall continue and remain in full force and effect as if no such forbearance or waiver had occurred. Governing Law. This Release shall be governed by, construed, and enforced in accordance with the laws of the State of       . Testimonial Release Form Page 1 of 2 Client Consent Form for Release of Confidential Information Notices. Unless provided herein to the contrary, any notice provided for or concerning this Release shall be in writing and shall be deemed sufficiently given when sent by certified or registered mail if sent to the respective address of each party as set forth at the beginning of this Release. Mandatory Arbitration. Notwithstanding the foregoing, and anything herein to the contrary, any dispute under this Release shall be required to be resolved by binding arbitration of the parties hereto. If the parties cannot agree on an arbitrator, each party shall select one arbitrator and both arbitrators shall then select a third. The third arbitrator so selected shall arbitrate said dispute. The arbitration shall be governed by the rules of the American Arbitration Association then in force and effect. Entire Release. This Release shall constitute the entire Release between the parties and any prior understanding or representation of any kind preceding the date of this Release shall not be binding upon either party except to the extent incorporated in this Release. Modification of Release. Any modification of this Release or additional obligation assumed by either party in connection with this Release shall be binding only if placed in writing and signed by each party or an authorized representative of each party. I am at least 18 years of age and am competent to contract in my own name. I have read this Release before signing below and I fully understand the contents, meaning, and impact of this Release. WITNESS my signature on this the       day of       , 20       . (Signature of Client)       (P rinted Name of Client ) Testimonial Release Form Page 2 of 2 Client Consent Form for Release of Confidential Information