This consent statement authorizes administrative personnel of
the Department of Intercollegiate Athletics at Chapman University
to review and disseminate to third parties information on this form
and other education information contained, collected or maintained
by Chapman University, for the purposes of public relations and
publicity. The information on this form will assist in compilation
of personal information for use in official departmental
publications for the media and public, for the purposes of
nominating me for honors programs, scholarships and awards, and for
other public relations purposes deemed appropriate by officials of
the Chapman University Department of Intercollegiate Athletics.
Also, by submitting this online form, I irrevocably
authorize Chapman University, its employees, and its agents, to use
my name, picture, and likeness as recorded by the University prior
to the date of this Release for any purpose that the University
deems appropriate, including promotional or advertising efforts. I
specifically authorize the University, its employees, and its
agents, to use, reproduce, exhibit, or distribute my name and
likeness for such purpose in any communications medium currently
existing or later created, including without limitation print
media, television, and the Internet.