Name & Title (Mr./ Ms./ Rev./ D. Min./ M. Div./ Ph.D./ M.D. *

First Name

Last Name

Phone

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Podcast Guest Release Agreement - I hereby voluntarily and without compensation authorize voice and video recording(s) to be made of me. I hereby give permission to Marriage Success Podcast and Dr. David Stephens to use, reproduce, and distribute the voice /video recordings, including my name and submitted photo(s). I hereby agree to release Marriage Success Podcast and Dr. David Stephens from any claims, damages or liability arising out of such use or distribution. I understand that the use of my name, likeness, and voice / video recordings will be primarily for the purposes of commercial use, education and/or promotion by this organization. I have read and understand the foregoing and I consent to the use of my picture /video and/or voice as specified for the above-described purpose(s). I further understand that no royalty, fee or other compensation of any character shall become payable to me. *

I agree to the above audio /video / media release