Consent for Media Coverage

  • I do hereby give my permission for Newman Regional Health public relations officials, other designated hospital officials, or employees of local/regional media, to interview, photograph, audio record, video record, use my photograph or image, and use any verbal or electronic communication for the purposes indicated below.
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    Newman Regional Health
    1201 W 12th Avenue
    Emporia, KS 66801
    Newman Medical Plaza
    1301 W 12th Avenue
    Emporia, KS 66801