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.

Name

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).