Registration Media Release "*" indicates required fields Student InformationName* First Last PSI City*Select OneBoise, IDCalgary, ABDallas, TXDenver, COEdinburgh, UKFort Wayne, INHonolulu, HIHouston, TXLas Vegas, NVNew York, NYOrange County, CAPhoenix, AZPortland, ORSan Francisco, CASeattle, WAToronto, ONVancouver, BCWashington, DCOther/UnknownEmail* Enter Email Confirm Email PSI Course/Event*Select OnePSI Basic SeminarPSI Life Success Course (PSI-7)PSI Leadership Seminar (MLS/WLS)PSI 50th AnniversaryRace to AbundancePacesetters Leadership Dynamics (PLD)InTENtion CoachingMedia Consent and Authorization*I hereby consent to and authorize PSI Seminars, LLC (hereafter “PSI Seminars”), its affiliates, agents, representatives and all persons or corporations acting with its permission or upon its authority (collectively the “Producer”), to use my name, voice, photograph, video image and likeness, together with my quotes, letters, endorsements and testimonials, whether written or oral, in whole or in part (described as the “Communication”), in connection with the exhibition, merchandising, advertising, endorsement, promotion, distribution, sale and any other activities (the “Program”) relating to the marketing and sale of training programs, intellectual properties, or software (the “Product”) referred to in my Communication. This right shall include the right to Incorporate and use the Communication in any video, audio, photograph, catalog, packaging, and package inserts and all other media, and to reproduce, exhibit, broadcast, transmit and distribute advertising containing the Communication relating to the Product. I hereby assign and agree to assign in perpetuity to PSI Seminars any and all worldwide rights, including the copyrights and renewals thereof, in, and to the advertising and the uses to which it may be applied. I agree to execute in the future any further documents that may be necessary to perfect PSI Seminars’ ownership rights in any advertising or other works containing the Communication. I certify that I am a bona fide user of the Product. I certify that my endorsement of, or testimonial about, the Product in the Communication is true and accurate and reflects my honest beliefs and real experiences in the quality and benefits of the Product that can be experienced by an average consumer. If at any time, I believe that my endorsement or testimonial as contained in the Communication is no longer true, accurate, and reflective of my experience with the Product, I will promptly notify the Producer at the address below. I am providing the Communication and my endorsement or testimonial of my own free will, and I have not been paid or compensated in any way for giving my endorsement or testimonial. I acknowledge that the Producer has relied on my statements in producing the Program and selling the Product. I waive any and all rights to inspect or approve the Communication, advertising, or the uses to which it may be applied as provided for herein. I have read, understand, and agree to the Media Consent and AuthorizationEmailThis field is for validation purposes and should be left unchanged. Δ Privacy We will not share information that you provide us (including e-mail addresses). Security All personal information you submit is encrypted and secure.