Business Name Business Address - City, State Zip Business Phone - Business Fax E-mail: - Website: Date PHOTO RELEASE FORM Subject's name: ____________________ I, ___(signee)___, hereby give __Business Name__ and their legal representatives and assigns, the right and permission to publish, without charge, photographs taken on (Month/Date/Year) _______________ at (Locations or Events) _____________________________________ ________________________________________________________ ________________________________________________________. These photographs may be used in publications, including electronic publications, or in audio-visual presentations, promotional literature, advertising, or in other similar ways. CIRCLE ONE: Professional Name of Subjects MAY/MAY NOT be given. ..........................(insert professional name) I hereby warrant that I am over eighteen (18) years of age, and am competent to contract in my own name. Signature: ________________________________________ Month/Date/Year: _________________________________ Address: _________________________________________ City: ___________________ State/Zip Code: _______ If necessary, I can be contacted at (circle one): work home Telephone: _________________________________________ (optional) E-mail: ____________________________________ Photographer: _______________________________________ Disclaimer: Above information is held in confidence and is never released or sold.

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Friday, August 10, 2007