I am willingly having my picture taken and my voice recorded, and I grant permission to
use my picture, my voice and physical surroundings without restriction or compensation for
the purposes of this project, be it print, video, internet web site, radio or any other media.
I expressly release Diversified Maintenance Systems, LLC and Diversified Maintenance -
RWS, LLC or representatives of these and any other institution transmitting or exhibiting
my voice or picture (hereinafter “Diversified Maintenance”) from any claims arising from
such use or distribution.
I agree to be fully responsible for my own participation and hold Diversified Maintenance
or representatives harmless from any liability, loss of expense arising from the use of my
picture or voice. I also consent to the use of my name, my voice and/or picture, and other
materials about me for promotional, publicity or any organizational purposes.
Print Name: ________________________________________________
Sign & Date: _____________________________________________________
Address: __________________________________________________
Phone: ________________________
Representative from Diversified Maintenance:
Sign & Date: ___________________________________ _______________________
Project description/notes:
Website stories/bios