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Release With Authorization To Photograph

Release executed on (date) by (name) of (address), here referred to as releasor, in favor of (photographer) of (address), here referred to as releasee.

In consideration of $------, receipt of which from releasee is acknowledged (or recite other consideration), releasor hereby consents to being the subject of the photographs of releasee, together with any subject matter owned by releasor, and hereby authorizes releasee to cause the same to be exhibited, with or without advertising sponsorship, as still photographs, transparencies, motion pictures, television, video or other similar media.

Releasor hereby releases releasee, and any associates, as well as any assignees, from any and all claims for damages for libel, slander, invasion of privacy or any other claim based on use of the above-described material(s).

In witness whereof, releasor has executed this release at (designate place of execution) on the day and year first above written.

Dated:

_______________________

Signature

(Acknowledgment, if desired)

*** If Required By State Law ***

This Section for Notary:

ACKNOWLEDGMENT

State of _________

County of ________ [COUNTY]

On [DATE] before me, [NAME OF NOTARY], notary, personally appeared [NAME OF PERSON(S) INVOLVED], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

Witness my hand and official seal.

Signature ________
Notary

My commission expires: _____

(Seal)