In consideration of my employment with the ___________________ (name of firm), 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. The Company is hereby authorized to use or cause to be used the 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.

The 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: ______________________ ___________________

Date ___________________