Book Launch Publicity Consent Form
Book Launch Publicity Consent Form
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Role
*
Please Select
Author
Publicist
Publisher Representative
Other
Book Title
*
Organization or Affiliation
Publicity Use Approved (describe what content or likeness may be used)
*
Approved Media/Channels
*
Print (magazines, newspapers, etc.)
Online (websites, blogs, digital articles)
Social Media
Radio/Podcast
Television
Event Promotion Materials
Other
Consent Timing/Duration
*
Please Select
One-time use only
For this book launch campaign only
Ongoing use (no time limit)
Other (please specify below)
Constraints or Exclusions (please specify any restrictions)
Consent Declaration: I authorize the use of my name, likeness, and/or provided content for publicity purposes related to the book launch as indicated above. I understand this consent is voluntary and can be withdrawn at any time by notifying the organizer in writing.
*
I agree and provide my consent
Submit Consent
Should be Empty: