Consent to Photograph Form

Fields marked with an * are required
I herby authorize representatives of NEWCOM Wireless Services (NEWCOM), to photograph, videotape or use other appropriate electronic media recording of me (hereafter collectively referred to as photographs) with the following restrictions:

I understand that these photographs of me may be used in Marketing / Public Relations by the above named facility in all forms of media. I release and hold NEWCOM, its employees, agents, or affiliates harmless from any and all liability, claims, demands or causes of actions whatsoever arising from and in any way associated with taking, displaying or use of these photographs.

This release and indemnification shall be as broad and inclusive as is permitted by the State of Massachusetts. If any portion is held invalid, the balance shall continue to be in full force and effect.