Name
*
Phone
*
Email
*
Fields marked with a
*
are required
Job Reference
Move Date
Moving From
Moving To
Video File
*
By checking the "I agree to the release terms" box at the bottom I hereby authorize, NorthStar Moving Corporation and its affiliates to use my likeness, voice and video image, name and other information, to promote its programs and activities. I specifically agree that the video may be used on NorthStar Moving’s website and sent to their clients and potential prospects. I also agree to have the video posted on YouTube or any other internet sites. I hereby release and waive for myself all claims for damages and waive any and all claims or rights to remuneration or payment of any kind that may arise from or are related to any publication or use of pictures or information indicated above. I specifically release NorthStar Moving Corporation from all such claims.
I agree to the release terms