Authorization & Release Information

  • I understand my testimonial as outlined above and made on behalf of Scioli & Associates, P.C. may be used in connection with publicizing and promoting Scioli & Associates, P.C. I authorize Scioli & Associates, P.C. to use my name, brief biographical information, and the testimonial as defined in this form.

    I hereby irrevocably authorize Scioli & Associates, P.C. to copy, exhibit, publish or distribute the testimonial for purposes of publicizing Scioli & Associates, P.C.'s programs or for and other lawful purpose. These statements may be used in printed publications, multimedia presentations, on websites or in any other distribution media. I agree that I will make no monetary or other claim against Scioli & Associates, P.C.for the use of the statement.

    In addition, I waive any right to inspect or approve the finished product, including written copy, wherein my likeness or my testimonial appears.

    I hereby hold harmless and release Scioli & Associates, P.C.from all claims, demands and causes of action which I, heirs, representatives, executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have reason of this authorization.
    By checking this box,I am allowing Scioli & Associates, P.C. to use non-identifying description of my case and to label it with only my first name in any printed publications, multimedia presentations, on websites or any other distribution media.
    By checking this box,I am allowing Scioli & Associates, P.C. to use non-identifying description of my case and to label it with only anonymous in any printed publications, multimedia presentations, on websites or any other distribution media.
    By checking this box,I am respectfully requesting that Scioli & Associates, P.C. do not use any of the provided information in any printed publications, multimedia presentations, on websites or any other distribution media.
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