Thank you for agreeing to share your name, story, video, audio, photograph, data or written quote (separately or collectively the “Testimonial Material”) with Burlington English Inc. and its affiliated companies (“Burlington”).

By signing the form below, you acknowledge that you have the right to release the Testimonial Material to Burlington.

You further confirm by signing the form below, that you give your irrevocable permission to Burlington to use the Testimonial Material in its educational or promotional materials in all media formats, including but not limited to online, digital, print, audio or visual formats.

You hereby waive all rights to inspect any Testimonial Material prior to its use and acknowledge and accept that you will not have any claims against Burlington or its affiliates for using the Testimonial Materials. In addition, you will not receive, or have any claim to receive, any compensation, payment or royalty from Burlington, in the present or in the future, for the use of any Testimonial Material.