Fill and Sign the Release Authorization Record Form

Release and Authorization to Record Model’s Voice and take Model’s Picture Release executed on       day of       , 20       , by       , of       , (Name of Model) (Street Address, City, County, State, Zip Code) hereinafter called the Releasor, in favor of       of (Name of Photographer)       , hereinafter called the Releasee. (Street Address, City, County, State, Zip Code) For and in consideration of $       , receipt of which from Releasee is acknowledged, Releasor, being of lawful age, releases Releasee, his licensees, agents, successors and assigns from all liability for claims and demands arising out of the agreement as set forth below. Releasor authorizes Releasee to record her picture and voice on photographs, films, audiotapes and videotapes, to edit these recordings at his discretion, and to incorporate these recordings into movie and sound films or audio- and videotapes, broadcasts (radio and television, including cable and satellite transmissions) programs, or otherwise, and to use and license others to use such recordings, movie and sound films and audio- and videotapes and broadcast programs in any manner of media whatsoever, including unrestricted use for purposes of publicity, advertising and sales promotion and to use Releasor's name, likeness, voice and biographic or other information in connection with the same. Releasor further agrees to indemnify and save harmless Releasee, his licensees, agents, successors and assigns, from any and all claims and liability for damages, losses or expenses of any sort arising from the making of such recordings and their use. Releasor further acknowledges that, except for the above-stated compensation, there were no promises of any compensation for such use by Releasee or by anyone associated with Releasee and, that Releasee exclusively owns all rights to these recordings regardless of the form in which they are produced or used. Releasor warrants and agrees that she has read and understood the contents of this release, and that she has the right and authority to execute this release and indemnification. Witness my signature, this the       day of       , 20       . (Signature of Releasee)       (Printed Name of Releasee) (Acknowledgement before Notary Public) Release and Authorization to Record Model’s Voice Page 1 of 1