MODEL  RELEASE

In consideration of my engagement as a model, and for other good and valuable consideration herein acknowledged as received, I hereby grant the photographer ______________________________, his agents, his heirs, legal representatives and assigns, those for whom he is acting or those acting with his authority and permission, the irrevocable and unrestricted right and permission to copyright, in his own name or otherwise, and use, re-use, and/or publish photographic pictures of me or in which I may be included, in whole or in part, or composite or distorted in character or form, without restrictions as to changes or alterations, in conjunction with my own name or a fictitious name, or reproductions thereof in color or otherwise, made through any medium at his studios or elsewhere, and in any and all media now or hereafter known for illustration, promotion, art, editorial, advertising, trade, or any other purpose whatsoever.  I also consent to the use of any printed matter or text in conjunction therewith.

I hereby waive any right I may have to inspect or approve the finished product or products and the advertising copy or other matter that may be used in conjunction therewith or to which it may apply or be applied.

I hereby release, discharge and agree to save harmless the photographer, his agents, tradenames, heirs, legal representatives and assigns, and all persons acting under his permission or authority or for whom he is acting, 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 taking of said pictures or in any subsequent processing thereof, as well as any publication thereof, including without limitations any claims for libel or invasion or privacy.

I hereby warrant that I am full legal age, (18 or over), and have the right to contract in my own name.  I have read the above authorization, release, and agreement, prior to its execution and I am fully familiar with the contents thereof.  This release shall be binding upon me and my heirs, legal representatives, and assigns.

________________________________                    ____________________________________

Model                                                              Social Security Number

________________________________                    ____________________________________

Date of Birth                                                    Today's Date

Signed:             This _______________ Day of ___________________________________ 20________

By:            ______________________________________________________________________________

Model's Signature

Witnessed:            This _______________ Day of ___________________________________ 20________

_________________________________                  ____________________________________

Witness Signature                                                          Witness Printed Name