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Name Consent Form

Samy Tshileu reflects upon and shares his life journey in the form of memoirs, philosophy and some aspects of theology. These writings hope to educate, inspire, empower, encourage and spread love, in order to influence positive change within one’s life and community. His books are inscribed with the philosophy of good overcoming bad and aim to challenge people to view the bright side of life’s situations instead of the dark one. He further encourages people to move forward by making right decisions that can inspire hope. 

Please check one or more of the boxes and fill in the blank

By submitting this form, I give Samy Tshileu the consent to use the checked name and/or the typed name above in his current and future writings in his memoir series, trilogies, novels, and essays.  By giving this consent, I agree that I will not ask for or receive payment for the use of my name in his writing, nor will I enter into any litigation against him in connection with the content of his writings or the use of my name. 

Thank you for giving Samy Tshileu the permission to use your name

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