I understand that the information provided above may be used or published through any medium, including the internet. Any right to inspect or approve the finished product or the advertising or other copy of the designated material is waived. National Disability Institute is released from any liability that may arise out of the use of the likeness, video film recordings, portraits, photographic likenesses, testimonials, success stories and names in perpetuity. I authorize National Disability Institute, assigns and transferees to copyright, use and publish the same in print and/or electronically.

Please type full name to authorize use of information provided.

MENU