Small Business Growth Series

Which classes do you plan on attending? Please indicate below which sessions you plan to attend

What type of business do you operate? Please select from the below listing the business category your business is in. None selected Health Care Retail Food Service Light Manufacturing Professional Services Scientific Development Technical Services Other

Photo Release I, the undersigned, do hereby consent to the use by The Board of Trustees of the University of Illinois (“University”) of my image, voice, or both described below, in (1) the video, photograph, or audio recording described below; and (2) any video, photograph, or audio recording reproduced either in whole or in part from the video, photograph or audio recording described below: regardless of whether these materials are used for fundraising, advertising, publicity, or any other purpose on behalf of either the University or its Foundation. I warrant that I have the full right and authority to grant this consent. In addition, I waive all claims to compensation or damages based on the use of my image or voice, or both, by either the University or the Foundation. I also waive any right to inspect or approve the finished photograph or video or audio recording. I understand that this consent is perpetual, that I may not revoke it, and that it is binding on me, my heirs and assigns. I warrant that I am at least 18 years of age and that I am competent in my own name insofar as this consent is concerned, or that I am the parent or legal guardian authorized to sign on behalf of a person under age 18. I further attest that I have read this consent form and fully understand its contents.

Please indicate the ethnicity distribution of the YOUTH participants. University of Illinois Extension wants to ensure that we are presenting programs to a wide range of people. This information will not be used to identify any program participants. It is used to collect data on the impact of our programming.