Use this form to submit your testimonial regarding ICPM and it’s certification programs Testimonial Submission Contact InformationName(Required) First Last Email(Required) Testimonial InformationWhich testimonial type would you like to submit(Required) Written Testimonial Video Testimonial Written TestimonialsComplete a written testimonial with a minimum of 75 words and receive 2 PDU points towards your PDU requirements Video Testimonial UploadAccepted file types: mp4, avi, mov, Max. file size: 64 MB.Consent & SubmissionConsent(Required) I understand my testimonial as outlined above or in the video recorded of me (the “Testimonial”) and made on behalf of ICPM (hereinafter called “The Business”) may be used in connection with publicizing and promoting The Business. I authorize The Business to use my name, brief biographical information, and the Testimonial as defined on this form or by me in this video. I hereby irrevocably authorize The Business to copy, exhibit, publish or distribute the Testimonial for purposes of publicizing The Business’ programs or for any other lawful purpose. These statements may be used in printed publications, multimedia presentations, on websites, or in any other distribution media. I agree that I will make no monetary or other claims against The Business for the use of the statement. In addition, I waive any right to inspect or approve the finished product, including a written copy or edited video wherein my likeness or my testimonial appears. I hereby hold harmless and release The Business from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.CAPTCHAPlease enter the answer to this math problem
