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I hereby consent to the use and license of my recorded name, likeness, voice, performance, biography, image and/or composition by MORT CRIM COMMUNICATIONS, INC. (MCCI) and its client, Michigan Nonprofit Association (MNA), in producing and/or promotion of video production, photography, print production, web, social media content and/or marketing purposes and in all versions and adaptations thereof, to be used for any and all purposes relating to the 2020 Census Michigan Nonprofits Count Campaign.

I acknowledge that I am 18 years of age. If under 18 years of age, I acknowledge that I am the legal guardian and provide my consent for this purpose. I acknowledge that my presentation may be edited as desired by MCCI and that it may broadcast, rebroadcast, webcast, printed, displayed, distributed or posted for perpetual internet availability as MCCI sees fit throughout the United States and abroad. I further agree that any other distribution agency, advertising medium, broadcast station and/or cable system, webcast systems may use my name, likeness, voice, performance, biography, image and/or composition for publicity and promotional purposes in connection with the marketing, promotional or communications materials, as described herein. I agree that the program and the copyright shall belong to MCCI and/or its client and shall be free from any claim thereto by myself.

Further, I hereby waive and forego any compensation for any usage as described herein; and I hereby release MCCI, MNA and their subcontractors, including, but not limited to any of their affiliates, from any liability arising from the use of this program material and/or commercial materials created by MCCI or furnished by me in connection with its production.