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Terms & Conditions: I give permission to Christian Counseling Ministries of Western New York, Inc. the absolute right and permission to copy, publish, my testimonial regarding myself. I give permission to use the first name, last name initial, or initials I have provided for publication. If I choose, I am voluntarily disclosing my legal name releasing or discharging Christian Counseling Ministries of Western New York, Inc. from any liability on disclosing this information. I understand and agree it is for the purpose of art, advertising, trade, or any lawful purpose whatsoever in combination with my own or fictitious name. I, also, grant the absolute right and permission to Christian Counseling Ministries of Western New York, Inc. to copy, publish, or use written testimony by me.

I waive any right that I may have to inspect and/or approve the finished product of the advertising copy. I also waive what the final product is in connection with or how it may be applied.

I release or discharge Christian Counseling Ministries of Western New York, Inc. from any liability of~~,~~ alteration, distortion, optical illusion, or use in composite form that may occur, intentional or otherwise, the processing of media~~.~~ I grant Christian Counseling Ministries of Western New York, Inc. indefinite use of this agreement and have the right to revoke this agreement at any time in writing by contacting CCM. I testify that I am at least 18 years old, the legal custodial parent or legal guardian of family members referenced.

Christian Counseling Ministries of Western New York, Inc. has my permission to use my testimony in all media purposes.

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