Name *

First Name

Last Name

Disclaimer: By submitting this statement, you agree to the following: *

1. Your statement may be used in campaign materials, including but not limited to advertisements, social media posts, and promotional materials. 2. Your statement may be edited for clarity, length, or grammatical correctness, but will not be altered in a way that changes its meaning or intent. 3. You authorize the campaign to use your name, likeness, and any other information provided in connection with your statement. 4. You understand that your statement may be made public and used in various media formats, including online and offline. 5. You affirm that your statement is truthful and accurately reflects your opinions and beliefs. 6. You release the campaign, its agents, and affiliates from any liability related to the use of your statement in campaign efforts. 7. You understand that this agreement is voluntary and can be revoked at any time by contacting the campaign in writing.

I agree

I agree, but would like to remain anonymous.