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The City of Balch Springs appreciates and values your input in regard to interaction of the public with the City’s Neighborhood Services Department (“the Department”) and its efforts to assist citizens of the City. Accordingly, the City would like to have authority to use your testimonial statement, as well as your name and photo in connection with the Department’s work, but will not do so without your written permission. Accordingly, please complete the authorization below in connection with publicizing and promoting, the department.
in connection with the Department’s publicizing of its programs. I hereby authorize the Department to copy, exhibit, publish, or distribute the items identified above in printed publications, multimedia presentations, on websites or in any other distribution media. I agree that I will make no monetary or other claim against the City of Balch Springs or the department for the use of this statement.
I hereby hold harmless and release the City of Balch Springs and the department from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators or any other person acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I have read the authorization and release information and give my consent for the use as indicted above.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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