Name, Image & Likeness Disclosure Form
Email
Secondary Email
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Email address *
Name
Sport
Phone
Email
Description of NIL Activity
Name of Company/Person that NIL deal is with* *
What are the terms of the agreement? *
Date activity will begin *
Date activity will end
Did you use, or plan on using, an agent or legal representation?* *
Yes
No
How will you be compensated? *
If you will be compensated with money, please the list the amount: *
Will any college facilities be used for this activity?* *
Yes
No
Will the Bergen logo be used? *
Yes
No
Signature of Student-Athlete *
Date *
Submit
* required field