Waiver Form

[photos | testimonials | video | artwork | profiles | stories]

MediGO, Inc. has my permission to use my photograph, video and audio recordings, likeness, artwork, profile, testimonial and/or story for publications, web pages and other promotional materials produced, used by, and representing MediGO, Inc. I understand the circulation of the materials could be worldwide and that there will be no compensation to me for this use.


Name(Required)
Reset signature Signature locked. Reset to sign again
MM slash DD slash YYYY