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Media Release

I hereby grant the CBA Provider Network permission to use my likeness in a photograph, video, or other digital media in any and all of its publications, including web-based publications, without payment or other consideration.

I hereby irrevocably authorize the CBA Provider Network to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.

I hereby irrevocably authorize the CBA Provider Network to use my experience of accessing Capacity Building Assistance (CPA) in digital media and in any and all of its publications, including web-based publications and products. Additionally, I waive any right to royalties or other compensation arising or related to the use of the story.

I hereby hold harmless, release, and forever discharge the CBA Provider Network from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.