Statement Authorization and Release Form

I give permission to Singerlewak (it’s representatives and employees) the right to use (via reprinting or other means of general distribution to the public) my written statements regarding Singerlewak, my name, likeness (if appropriate) and Company name (if appropriate).
I understand that my statement will be used in its entirety and that any modification of my statement will be presented to me for approval.
I may revoke this permission at any time with written notice sent to:

I have read, understand, and agree to the above.

Statement Authorization and Release Form