Allow Us To Share the Story of Your Experience with Mason SBDC Please Help Us Get The Word Out About Mason SBDC Services! Question Title * Please provide a statement about how the Mason SBDC helped you with your business: Question Title * Please list any additional materials that you are providing separately as part of the Testimonial (i.e. inventory of testimonial materials): Question Title * Authorization and Release Information: I understand my testimonial as outlined above (the "Testimonial") and made on behalf of Mason Small Business Development Center (Mason SBDC) may be used in connection with publicizing and promoting the Mason SBDC. I authorize Mason SBDC to use my name, brief biographical information, and the Testimonial as defined on this form. I hereby irrevocably authorize Mason SBDC to copy, exhibit, publish or distribute the Testimonial for purposes of publicizing Mason SBDC’s programs or for any other lawful purpose. These statements may be used in printed publications, multimedia presentations, on websites or in any other distribution media. I agree that I will make no monetary or other claim against Mason SBDC for the use of the statement. In addition, I waive any right to inspect or approve the finished product, including written copy, wherein my likeness or my testimonial appears. I hereby hold harmless and release Mason SBDC from all claims, demands and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. Name: * Company: * Address: * Address 2: City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code: * Email Address: Done