Permission for Photography

For valuable consideration received, I grant to Kimberly Gauthier ("Photographer") and her legal representatives and assigns, the irrevocable right to use and publish photographs, still or moving, of me or in which I may be included, for the restricted purposes of self selfpromotion, including advertising the Photographers business, in any manner and medium; and to alter and composite the same w without restriction and without my inspection or approval. I hereby release Photographer and her legal representatives and assigns from all nd claims and liability relating to said photographs. X SIGNATURE

(SEAL)

NAME

ADDRESS (Line 1)

ADDRESS (Line 2)

DATE X WITNESS

ADDRESS (Line 1)

ADDRESS (Line 2)