Media Consent and Release Form

By completing and submitting this webform, you authorize Alerus to use, reproduce, and/or publish all written and/or visual materials, including photographs, that may pertain to you.

Name(Required Field)
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Address(Required Field)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email(Required Field)
Phone(Required Field)
Authorization(Required Field)
I hereby authorize Alerus to use, reproduce, and/or publish all written and/or visual materials, including photographs, that may pertain to me. I understand that this material may be used in various publications, advertisements, media releases, recruitment materials, or for other related endeavors. This material may also appear on the Alerus website and social media accounts.

I understand that I can revoke this release at any time in writing and that the use of any of my photos or other information authorized by this release will immediately cease.

I am of legal age (18 years or older), have read the foregoing, and fully understand the contents thereof.
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