Fill and Sign the Request for Satisfaction Form

1 9.08 Form: Picture and Name Release For valuable consideration received, I, ________________________ (print full name), hereby irrevocably grant to MULTIMEDIA COMPANY, its subsidiaries, affiliates, nominees, licensees, their successors and assigns, and those acting with its authority (hereinafter collectively referred to as "MC"), with respect to the photographs, film or tape taken of me by or on behalf of MC (the "Pictures"), the unrestricted absolute, perpetual, worldwide right to: (1) Reproduce, copy, modify, create derivatives in whole or in part, or otherwise use the Pictures or any part thereof in combination with or as a composite of other matter, including, but not limited to, text, data, images, photographs, illustrations, animation and graphics, video or audio segments of any nature, in any media or embodiment, now known or hereafter to become known, including, but not limited to, all formats of computer readable electronic magnetic, digital, laser or optical-based media (the "Works"), and (2) Use and permit to be used my name, whether in original or modified form, in connection with the Works as MC may choose, and (3) Display, perform, exhibit, distribute, transmit or broadcast the Works by any means now known or hereafter to become known. Waiver and Release I hereby waive all rights and release MC from, and shall neither sue nor bring any proceeding against any such parties for, any claim or cause of action, whether now known or unknown, for defamation, invasion of right to privacy, publicity or personality or any similar matter, or based upon or relating to the use and exploitation of the Pictures. I agree that there shall be no obligation to utilize the authorization granted by me hereunder. The terms of this authorization shall commence on the date hereof and be without limitation.I warrant and represent that I am _________________________ (insert "under" or "over") the age of eighteen years and that I am free
1 form: picture and name, with the following further conditions: i hereby irrevocably waive (or not be obliged to) all claims, proceedings, suits or causes of action of every kind, whether on a contract or type, arising out of, relating to, or in any way connected with this form; iii all claims of any kind that are pending or that may arise out of this form against any person (whether such person is the maker of any, the publisher of any, or the photographer or videographer of the, the, the picture; iv this form shall 1 form: picture and name, include all the information contained in the following subparagraphs with respect to the above form and all photographs and videos of or in connection with this form, other than information otherwise included or included to the best of my or mc's knowledge: the full names and full addresses of any person acting on behalf of, or in cooperation with, MC and all personal information held, used or collected by MC; 1 form: picture and name, as well as a true, complete and accurate description of mc's image or photographs taken of me by or on behalf of MC; 3, any other information that mc may, as it deems necessary or desirable: (a) verify, correct or supplement any information contained in this form or in the information that follows; (b) satisfy any requests relating to any of the information in this form; v 1. Any other information relating to this form that MC considers necessary or desirable. A printout, as defined in