Fill and Sign the Video Form

Employee Video, Photo and Recording Release For and in consideration of my employment with the ________________________ (Name of Employer) , (the Company ) and as part of the services being furnished by me to said Company, I hereby give my consent to the photographing of myself and to the recording of my voice. Company is hereby authorized to use or cause to be used said still photographs or motion picture footage, recordings of my voice and my name for advertising, publicity, commercial or other business purposes. Said photographs and/or recordings may be used singularly or in conjunction with other photographs and/or recordings. Company has my authorization to reproduce, or cause to be reproduced and used such photographs and voice recordings. The same may be exhibited in all domestic and foreign markets. I understand that others may use and/or reproduce said photographs and/or recordings with or without the Company's consent. I hereby release the Company, any of its associated or affiliated companies, their directors, officers, agents, employees, customers and the Company's appointed advertising agencies, officers, directors, agents and employees, from all claims of any kind on account of such use. Witness my signature this _________________ (date) . ___________________________ (Printed Name of Employee) ___________________________ (Signature of Employee) (Acknowledgment form may vary by state) State of _____________________ County of ___________________ Personally appeared before me, the undersigned authority in and for the said County and State, on this ___________________ (date) , within my jurisdic tion, the within-named __________________________ (Name of Employee) , who acknowledged that he executed the above and foregoing instrument. ________________________________ NOTARY PUBLIC My Commission Expires: ____________________