1. For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I hereby grant to __________, its agents (including, without limitation, __________ ), and others working for it or on its behalf, and their respective licensees, successors, and assigns (collectively, "Client") the unlimited right and permission to use, distribute, publish, exhibit, digitize, broadcast, display, reproduce, digitize and otherwise exploit my name, signature, picture, likeness, voice, social media handles, avatars, and biographical information, and any material based thereon or derived therefrom, together with any other materials (including without limitation any nonfictional or fictional material), or to refrain from so doing, in any manner or media whatsoever (whether now known or hereafter devised) anywhere in the world in perpetuity for the purposes of advertising or trade in promoting and publicizing Client and its products and services.
  2. I shall have no right of approval, no claim to compensation, and no claim (including, without limitation, claims based upon invasion of privacy, defamation, or right of publicity) arising out of any use, blurring, alteration, distortion, illusionary effect, faulty reproduction, fictionalization, or use in any composite form of my name, signature, picture, likeness, voice, social media handles, avatars and biographical information.
  3. I have the full and exclusive right and authority to grant the rights granted hereunder and I agree that this Consent and Release does not in any way conflict with any existing commitment on my part. I have not heretofore authorized (which authority is still in effect) nor will I authorize or permit the use of my name, signature, picture, likeness, voice, or biographical information in connection with the advertising or promotion of any product or service competitive to or incompatible with those of

___________________________                  ______________________________

Signature                                                          Signature of Witness

___________________________                  ______________________________

Name                                                               Name

___________________________                  If signatory is under 21, parent or

Address                                                           legal guardian must also sign below

                                                                        to signify agreement:


Social Security Number

___________________________                  ______________________________

Phone Number                                                      Signature of Parent/Legal Guardian

___________________________                  ______________________________

Date                                                                 Name, Address, and Phone Number