I authorize NCI to use our company name/logo and publicize our partnership in the following manner(s):

I understand my choice(s) below may be used in connection with publicizing and promoting NCI’s services. I authorize NCI to use my name, and the choice(s) as defined on this form. I authorize NCI to copy, exhibit, publish or distribute via the choice(s) for purposes of publicizing NCI’s services.

Newsletter

Website

Social Media

Press Release

Promotional Materials

Contact Name

First Name

Last Name

Contact Phone

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