Showcase Yourself: Media Profile Submission
Name
First Name
Last Name
Email
example@example.com
Your NPN
Headshot Upload
*
Browse Files
Drag and drop files here
Choose a file
Please upload a headshot of yourself. This may be used for creation of digital business cards and any system avatars.
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Would you like to be tagged and/or be featured in our social media campaigns/Website?
*
Please Select
Yes
No
Instagram Handle (optional)
LinkedIn URL (optional)
Facebook URL (optional)
Twitter/X Handle (optional)
Photos you would like to share (optional)
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Drag and drop files here
Choose a file
Example: Photos of you and your family
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Media Consent
*
I hereby grant Eterna the right to use my name, photograph, likeness, and submitted social media handles in internal and external communications, including but not limited to: print materials, digital publications, websites, social media, and other promotional or marketing formats. I understand that these materials may be used for an indefinite period unless I request removal in writing. I waive any rights to inspect or approve the final materials and understand that no compensation will be provided for this use.
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