Marketing and Communications Release Form

Marketing and Communications Release Form
Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Please select whether you are a
Parent/Guardian of Student

First NameLast Name
Year of Study
Program
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Huron has launched an Alumni Mentorship Program. In the future, would you be potentially interested in being a Mentor?

Other
Authorization, Release, and Consent
Please check the boxes to agree to the below statements:
In signing this agreement, I acknowledge that I have carefully read this document, I understand it, and agree to be bound by its terms. I further acknowledge that I sign this Release Agreement voluntarily and am at least eighteen years of age.
Name

First NameLast Name
Signature
If you would prefer to take a photo of your signature, please upload an image below.

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Should be Empty:

Authorization, Release, and Consent