Media Release Form Thank you for sharing with Us! Media Release Form YOUR INFORMATION IS CONFIDENTIAL. Kingdom’s Restoration, collects the information below to ensure effective communication and volunteer recognition. Name First Last Street Address:*City:*State:*ZIP Code:*Phone:*E-mail:* Today's Date*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920SIGNATURESInitials*Type initials hereTerms of AgreementMEDIA RELEASE: By volunteering and or sharing information to Kingdom’s Restoration, you consent to your voice or likeness being used without compensation in films, videos, all media, print, publications, and social media, whether known or hereafter devised. You release Kingdom’s Restoration, media affiliates, and their successors assigns and licensees from any liability on account of such usage. * Read the Terms of Agreement CAPTCHA Δ