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Social Media Consent/Release Form

For News Media, Promotional Materials, Written Articles, Research and/or Photographs

I,                                                                          hereby authorize Michael A. Gaytan- Trainer to use my photo and/or information related to my experiences with Fuel n’ Burn Fitness.

I understand this information may be used in publications, including electronic
publications, audiovisual presentations, promotional literature, advertising,
community presentations, letters to area legislators and media and/or other similar

Michael A. Gaytan- Trainer will disclose to me or my legal representative, where
appropriate, the specific information and/or photo to be used prior to release in the
social media. My consent is freely given as a public service to Fuel n’ Burn Fitness,
without expecting payment.

I release Michael A. Gaytan- Trainer and Fuel n’ Burn Fitness from any and all liability
which may arise from the use of such news media stories, promotional materials,
written articles, videotape and/or photographs.


Your Form has been Submitted!

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