MEDIA RELEASE AGREEMENT: By checking the box below I hereby consent to release for possible publication my name and/or photos and/or video images taken by any authorized Kellogg Insurance representative for news and/or publicity purposes. This may include Kellogg Insurance and/or Integrity Marketing Group publications (newsletters, flyers, brochures, social media websites, web pages, etc.). I also agree to allow the publication or broadcast of my name in connection with any photos and/or video images taken, and I understand that I will not receive remuneration for my voluntary participation or future use of any photos and/or images of me. This consent remains in effect indefinitely unless notice of revocation of authorization by consenter is submitted in writing to Kellogg Insurance Marketing. For more information, please contact shawn@kelloggins.com.