!"#"$%" '(!

)

8y slgnlng Lhls release form, l auLhorlze [?Cu8 C8CAnlZA1lCn], Lo use Lhe followlng personal
lnformaLlon:

(1) My plcLure - lncludlng phoLographlc, moLlon plcLure, and elecLronlc (vldeo) lmages.
(2) My volce - lncludlng sound and vldeo recordlngs.

l hereby granL Lo [?Cu8 C8CAnlZA1lCn], lLs subsldlarles, llcensees, successors and asslgns, Lhe
rlghL Lo use, publlsh, and reproduce, for all purposes, my name, plcLures of me ln fllm or
elecLronlc (vldeo) form, sound and vldeo recordlngs of my volce, and prlnLed and elecLronlc
copy of Lhe lnformaLlon descrlbed ln secLlons (1) and (2) above ln any and all medla lncludlng,
wlLhouL llmlLaLlon, cable and broadcasL Lelevlslon and Lhe lnLerneL, and for exhlblLlon,
dlsLrlbuLlon, promoLlon, adverLlslng, sale, press conferences, meeLlngs, hearlngs, educaLlonal
conferences and ln brochures and oLher prlnL medla. 1hls permlsslon exLends Lo all languages,
medla, formaLs and markeLs now known or hereafLer devlsed. 1hls permlsslon shall conLlnue
forever unless l revoke Lhe permlsslon ln wrlLlng.

l furLher granL [?Cu8 C8CAnlZA1lCn] all rlghL, LlLle, and lnLeresL LhaL l may have ln all flnlshed
plcLures, negaLlves, reproducLlons, and coples of Lhe orlglnal prlnL, and furLher granL [?Cu8
C8CAnlZA1lCn] Lhe rlghL Lo glve, sell, Lransfer, and exhlblL Lhe prlnL ln coples or facslmlles
Lhereof, for markeLlng, communlcaLlons, or adverLlslng purposes, as lL deems flL.

l hereby walve Lhe rlghL Lo recelve any paymenL for slgnlng Lhls release and walve Lhe rlghL Lo
recelve any paymenL for [?Cu8 C8CAnlZA1lCn'S] use of any of Lhe maLerlal descrlbed above
for any of Lhe purposes auLhorlzed by Lhls release. l also walve any rlghL Lo lnspecL or approve
flnlshed phoLographs, audlo, vldeo, mulLlmedla, or adverLlslng recordlngs and copy or prlnLed
maLLer or compuLer generaLed scanned lmage and oLher elecLronlc medla LhaL may be used ln
con[uncLlon LherewlLh or Lo approve Lhe evenLual use LhaL lL mlghL be applled.

l acknowledge LhaL l have read Lhe foregolng and l fully undersLand Lhe conLenLs.


ln Wl1nLSS WPL8LCl, l have execuLed Lhls release on Lhls ____ day of __________, 2010.

rlnL name: 1elephone number:

Address: SlgnaLure:

ClLy/SLaLe/Zlp:




(lf release ls provlded on behalf of a mlnor:)

l hereby cerLlfy LhaL l am Lhe parenL or guardlan of ______________, who ls under Lhe age of
elghLeen years, Lo whom Lhls release applles and LhaL l have Lhe legal auLhorlLy Lo execuLe Lhls
release. l approve Lhe foregolng and agree LhaL we boLh shall be bound Lhereby.
arenL/Cuardlan: 1elephone number:

Address: SlgnaLure:

ClLy/SLaLe/Zlp:

WlLness: 1elephone number:

Address: SlgnaLure:

ClLy/SLaLe/Zlp: