Guest Name *

First Name

Last Name

Phone *

(###)

###

####

DATE OF APPEARANCE *

MM

DD

YYYY

I hereby consent to the recording and distribution of my voice and performance as part of “Open Mike Friday” and acknowledge that the Center for Supply Chain Studies (C4SCS) is the sole owner of the program recording, and that C4SCS has the right to use, house on its website, promote and distribute the program and that recording. My performance, along with my name, bio and photo, may be used in connection with the program. (DATE SIGNED) *

MM

DD

YYYY