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Statement RELEASE & CONSENT FORM
I give my permission for pictures and statements of myself, my spouse, my son and/or daughter, to be used by Herndon Chiropractic Clinic. I hereby transfer to Herndon Chiropractic Clinic all copyright and other interests in the photographs and/or statements "testimony" taken. I also hereby grant royalty-free permission, including nonexclusive world rights in all languages, to reproduce in all formats including but not limited to print and internet such as our Web Site.
I Agree to the above statement. *	Yes, I agree
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