Media Release Form

I hereby give Sana Lake Recovery consent to use my image and voice (in photographs, videos, audio recording, etc) to be used in the following ways:

• Company social media (all platforms)
• Print or digital employee newsletter
• Print or digital client customer newsletter
• Company website
• Company marketing: TV, Radio, Billboard, Print, Digital Ads, etc.

I further understand that no special compensation will be provided to me for use of my image or video and that I may not be informed in advance of the specific use of my image or video.



Name(Required)

Electronic Signature Acknowledgment and Consent(Required)
Type your name in the box to sign electronically.
MM slash DD slash YYYY