Fill and Sign the Release and Authorization to Use Name in Memoir to Be Published Form

Release and Authorization to Use Name in Memoir to be Published Release executed on __________________ (date) , by _______________________ of ____________________________________ (street address, city, county, state, zip code) herein referred to as Releasor, in favor of _________________________ of ____________________________________ (street address, city, county, state, zip code) herein referred to as Author . Whereas, Author is writing or has written his Memoirs entitled or to be entitled ____________________________________ (name of book), hereinafter called Memoirs; and Whereas, said Memoirs are or shall be an account of Author’s personal life and experiences _________________________________________________________ (have further description if necessary, e.g., as a combat infantryman in Vietnam); Whereas, Author has used or desires to use Releasor’s name in said Memoirs; Now, therefore, for good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, Releasor, being of lawful age, hereby expressly releases Author , his publishers, licensees, agents, successors and assigns (hereinafter jointly and severally called Releasees ) from all liability for claims and/or demands arising out of the agreement as set forth below, included, but not limited to, libel, slander, invasion of privacy or any other claim based on use of the name of Releasor in said Memoirs. I. Releasor hereby authorizes Releasees to use Releasor’s name in Releasees’ discretion, and to incorporate Releasor’s name into said Memoirs in Releasees’ discretion, and to use any information that Releasor has provided in any way to Releasees in connection with the preparation and/or publication of said Memoirs and in the promotion or advertising relating to the preparation and/or publication of said Memoirs . II. Releasor further agrees to indemnify and save harmless Releasees from any and all claims and liability for damages, losses or expenses of any sort arising from the making or the publication of said Memoirs. III. Releasor warrants and agrees that he has read and understood the contents hereof, and that he has the right and authority to execute this release and indemnification. In witness whereof, the parties have executed this Release and Authorization Agreement on the date and year first above written. __________________________ ________________________ Releasor Author