Fill and Sign the Release Purposes Form

Release and Authorization to Use Photographs and Testimonials for Advertising Purposes Release executed on __________________ (date) , by ______________________ (name of person giving release) of ______________________________________________ _____________________________ (street address, city, state, zip code) herein referred to as Releasor , in favor of ______________________ (name of Releasee), of _______________ ____________________________________________________________ (street address, city, state, zip code) herein referred to as Releasee . Whereas, Releasee is a professional speaker in the area of ( describe type of subject matter in speaking engagements) ______________________________________________ ______________________________________________________________________; and Whereas Releasee desires to use photographs and testimonials of participants willing to allow their photographs and statements to be used on his website _______________________ (website address) , YouTube, and similar such media for advertising purposes; Now, therefore, for and in consideration of the mutual covenants contained in this Agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: 1. Releasor hereby authorizes Releasee to record his/her picture and voice on photographs, films, audio and videotapes, to edit same at his discretion, and to incorporate these photographs, recordings, Releasor’s likeness, voice, biographical information, or other information in connection therewith, into media form for advertising on said website, YouTube, and similar such media, including the unrestricted use for purposes of publicity, advertising and sales promotion. 2. Releasor further agrees to indemnify and save harmless Releasee, its 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 photographs, 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 photographs and recordings regardless of the form in which they are produced or used. 3. Releasor warrants and agrees that he/she has read and understood the contents hereof, and that he/she has the right and authority to execute this release and indemnification. In witness whereof, the parties have executed this release and indemnification agreement at (designate place of execution) _______________________________________ ____________________________________ on the date and year first above written. ________________________________ ______________________________ Releasor Releasee ________________________________ (Name of Releasor) By___________________________________ (Signature of parent or legal guardian)** ** (If Releasor under 18)