Signer must be 18 years of age. If the party is under the age of 18, a parent or legal guardian must sign this release. Please read carefully.

In consideration of the charitable work provided by United Way for Southeastern Michigan (United Way), the undersigned does hereby authorize the use of his or her name and or likeness by United Way, its affiliates, subsidiaries, agents or employees in articles or publications for promotional, educational, informational or any other purpose without limitations, and the undersigned does hereby release United Way as to any liability to the undersigned or his or her heirs or assigns arising from or in any way related to the above authorized use of the undersigned’s name or likeness, including liability for any express or implied inaccuracies, disclosures or innuendoes.

The undersigned acknowledges that he or she is not signing this Authorization and Release in reliance upon any statement or representation regarding the manner or extent of the use of the undersigned’s name or likeness by United Way. The undersigned also acknowledges that this Authorization may only be revoked by written notice provided to United Way at least 30 days prior to the effective date of such revocation and that United Way will not be liable for any distribution of material containing or referring to the undersigned’s name or likeness made prior to the effective date of such revocation which material is published or circulated by others subsequent to that effective date.