"*" indicates required fields This release form is to be completed by all people whose stories TFL proposes to use in our direct response fundraising program, brochures, websites, social media, annual reports, and newsletters. I/we authorize that my name, information about me, and my relationship to Technology for Living (TFL) be released to TFL, along with selected photographs/ video images of me (as described below). I authorize TFL to use this information and/or images for their sole purpose in any promotional or fundraising materials on their websites, in their social media or annual report, and the TIL and PROP newsletters (Balance). Description of Photograph/Images: Still photos and video taken at the time of assistive technology home visit, including pictures of me using the technology. This release is valid until TFL receives written notification revoking this release. A photocopy of this original form may be used as required.Name* Phone*Email* Address* Street Address City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Upload File(s) Drop files here or Select files Max. file size: 100 MB. Aggreement* I agree and understand that TFL accepts no obligations or financial responsibilities if a photograph is used.CAPTCHANameThis field is for validation purposes and should be left unchanged.
"*" indicates required fields