Image ReleaseNameThis field is for validation purposes and should be left unchanged.Authorization and Release for Personal ImageConsent(Required) I give DIAGNOSTIC LABORATORY SERVICES, INC., (“DLS”), permission to photograph or record my image, voice and/or likeness and grant DLS all rights to use these recordings or photographs (“Images”) for purposes related to the business of DLS, including, but not limited to, an employee directory, company promotions, advertisements or social media. I further understand and agree that these Images may be used by DLS without payment of fees to me or to anyone else on my behalf. I hereby relinquish all rights, title and interest therein to DLS. I waive the right to approve the final product. I hereby release and hold harmless each of DLS and its respective officers, directors, shareholders, employees, agents, contractors, affiliates, successors, and assigns, and their affiliates from any claims, demands, rights, promises, damages and liabilities arising out of or in connection with the use of the Images.Name:(Required) First Last Email:(Required) Phone:Event Name:Event Date(Required) MM slash DD slash YYYY SignatureCAPTCHAΔ
