Release Form - The Devan Group

Project Name
Participant Name (please print)
Choose Project Name*
I agree to allow The DeVan Group, LLC and/or its partners to publish, copyright, and use my story and/or picture(s) in print and electronic formats such as publications, videos, projects, and websites. I understand that my story and/or pictures may be published in any of these media without restriction.
Although not obligated, in support of making this project successful, I will do my best to encourage a minimum of at least five (5) family members or friends to preorder a copy of my book.
I understand that I will not receive payment or other compensation for use of my story or photos.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Enter Email Confirm Email
Typed name of Participant*
Phone*
Authorization
My typed name and electronic signature constitute a binding agreement between myself and The DeVan Group, LLC
- I am 18 years of age or older
- I am younger than 18 years of age
Signature of Participant*
Parent/Guardian Name*

For participants under 18 years of age
Signature of Parent/Guardian*

Save and Continue Later

I am 18 years of age or older

I am younger than 18 years of age

Signature of Participant

[PRINT NAME]

Date

Signature of Parent/Guardian (for participants younger than 18)

[PRINT NAME]

Date

Contact Info:

Email Address

Phone number

Mailing Address

Country

City/State/Zip

PLEASE RETURN COMPLETED FORM TO:
The DeVan Group, LLC
9701 Apollo Dr., Suite 100
Largo, MD 20774, USA
PHONE: 240-232-6105
FAX: 301-542-0192