In consideration of the sum of $1.00 and other good and valuable consideration, receipt of which is hereby acknowledged, I, being of legal age, hereby give __________ (hereinafter MOVIE MAKER), and all licensees, successors, legal representatives and assigns of MOVIE MAKER, the absolute and irrevocable right and permission to use my name and to use, reproduce, edit, exhibit, project, display, copyright, publish and/or resell photographic pictures and/or moving pictures and/or videotaped images of me with or without my voice, or in which I may be included in whole or in part, and any of my possessions, including real and personal property, which pictures, images and possessions are photographed, taped, videotaped, and/or recorded on [date] ___________, 200__ and thereafter, and to circulate the same in all forms and media for art, advertising, trade, competition of every description and/or for any other lawful purpose whatsoever. I also consent to the use of any printed matter in conjunction therewith.

I hereby waive any right that I may have to inspect and/or approve the finished product or products or the editorial, advertising or printed copy or soundtrack that may be used in connection therewith and any right that I may have to control the use to which said product, products, copy and/or soundtrack may be applied.

I hereby release, discharge and agree to save harmless MOVIE MAKER, his/her licensees, successors, legal representatives and assigns from any liability by virtue of any blurring, distortion, alteration, optical illusion or use in composite form whether intentional or otherwise, that may occur or be produced in the making, processing, duplication, projecting or displaying of said pictures or images, and from liability for violation of any personal or proprietary right that I may have in connection with said pictures or images and with the use thereof.

Individual:_________________________________________
Print:___________________________________________
Witness:________________________________________
Date:__________________________________________