Marketing Material Release Form

A

Personal Information

First Name *

Last Name *

Birth Date *

Gender *

Phone Number *

Email *

B

Authorization and Release

What is your preference regarding the use of your name? *

You may select one or more options.

I consent to the use of my complete name. I consent to the use of my first name only. I consent to the use of my nickname. I consent to the use of my photographs anonymously.

Please check the boxes regarding your preference. *

You may select one or more options.

I authorize Pascal Resources Energy, Inc. to take my photographs, video, and narrative. I authorize Pascal Resources Energy, Inc. to use my photos on Facebook, Twitter, Instagram, other social media platforms, and other marketing materials they deem fit. I authorize Pascal Resources Energy, Inc. to edit, alter, copy, or distribute the photos for social media advertising and marketing. I agree that all intellectual property rights to the photos belong to Pascal Resources Energy, Inc. I agree that I will not receive monetary compensation for the use of my photographs on social media platforms.

C

Signature

Signature *

Draw your signature using your mouse or finger.