Photo Video Media Release Form

I hereby grant Northland Capital Financial Services, LLC (NCFS) and all it’s subsidiaries permission to use my likeliness in a photograph and/or video in any and all of its publications, including website, video channels and social media, without payment or any other consideration.

I understand and agree that these materials will become the property of NCFS and will not be returned.

I hereby irrevocably authorize NCFS to edit, alter, copy, exhibit, publish or distribute media for purposes of publicizing NCFS’s programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph.

This field is for validation purposes and should be left unchanged.

Authorization Name*

First Name Last Name

Email*

Consent*

I am 21 years of age and am competent to contract in my name. I have read this release and I fully understand the contents, meaning, and impact of this release.

Consent Children

If there is a child (children) present in the photograph or video, I hereby certify that I am the parent or guardian of such child (children) and give my consent without reservation to the foregoing on behalf of this child (children).