Syndrome Association

15201 Mason Road Sye100 #173   Cypress, TX 
77433, USA


Syndrome Europe

Van Sybergstraat 2, 7631 JE, Ootmarsum, The


October 4, 2017


Please let this letter serve as authorization to use your family’s
photographs and bio information on the Christianson Syndrome Association
Website, Christianson Syndrome Europe Website and any other official CS
affiliates or documents.  By signing this form you authorize the above
organizations to place your families (including your minor children) photographs
and bio information on the organizations websites, or their newsletters or


Deborah Nash


Christianson Syndrome Association


Monique Snijder


Christianson Syndrome Europe

*=Required fields

IDODO NOT consent to and authorize the use and reproduction by Christianson Syndrome Association & Christianson Syndrome Europe of any and all photographs and any other audio/visual materials taken of me, my family (including minor children) for promotional material, educational activities, exhibitions or for any other use for the benefit of the association.

Permission to use audio/visual materials from:

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