Media Release Form

Please fill out this form and click submit. If you have questions, please call Matthew at 210-822-8201 ext. 108 or email matthew@bebroken.com.
I hereby give permission to BE BROKEN MINISTRIES to use my initials in all forms and media for fundraising, advertising, and any other lawful purposes. I further give BE BROKEN MINISTRIES permission to reproduce my story and any quotes as revealed to them in all of the above publications. I hold harmless BE BROKEN MINISTRIES, staff, and volunteers from any liability relating to any information I reveal to them and agree to release for publication.
 
 
If a minor is involved in a story or quote: I also give permission to use the initials, story, and/or quote of my minor children listed below.
 
 
 
 
*Your name here represents your electronic signature, agreeing to the terms of this release form.

Email address: contact@bebroken.com

Mailing Address: Be Broken Ministries, 19115 FM2252 Ste 6, Garden Ridge, TX 78266

Description

Please fill out this form and click submit. If you have questions, please call Matthew at 210-822-8201 ext. 108 or email matthew@bebroken.com.