Startup Founder Publicity Consent Form
Provide your details and consent for the use of your information in publicity and promotional materials.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Startup/Company Name
*
Your Role/Title at the Startup
*
Company Website URL
Upload a Recent Photo (for publicity use)
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Short Founder Bio or Story (to be used in publicity materials)
*
Social Media Handles (LinkedIn, Twitter, etc.)
By signing below, you confirm your consent for the use of your name, image, and story as described above.
*
Date of Consent
*
-
Month
-
Day
Year
Date
Submit Consent
Submit Consent
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