Release With Authorization To Photograph

Release executed on __________ (date), by ________________ (name) of ______________ (address), here referred to as releasor, in favor of __________________ (photographer), of ____________ (address), here referred to as releasee.

In consideration of $____, receipt of which from releasee is acknowledged (or recite other consideration), releasor hereby consents to being the subject of the photographs of releasee, together with any subject matter owned by releasor, and hereby authorizes releasee to cause the same to be exhibited, with or without advertising sponsorship, as still photographs, transparencies, motion pictures, television, video or other similar media.

Releasor hereby releases releasee, and any associates, as well as any assignees, from any and all claims for damages for libel, slander, invasion of privacy or any other claim based on use of the above-described material(s).

In witness whereof, releasor has executed this release at _______________ (designate place of execution) on the day and year first above written.

Date: ___________.

_______________________

Signature

(Acknowledgment, if desired)

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