MODEL RELEASE

For and in consideration of my engagement as a model by Richard F. Wise, hereafter referred to as the photographer, on terms or fee hereinafter stated, I hereby give the photographer, his legal representatives and assigns, those for whom the photographer is acting, and those acting with his permission, or his employees, the right and permission to copyright and/or use, reuse and/or publish, and republish photographic pictures or portraits of me, or in which I may be distorted in character, or form, in conjunction with my own or a fictitious name, on reproductions thereof in color, or black and white made through any media by the photographer at his studio or elsewhere, for any purpose whatsoever; including the use of any printed matter in conjunction therewith.

I hereby waive any right to inspect or approve the finished photograph or advertising copy or printed matter that may be used in conjunction therewith or to the eventual use that it might he applied.

I hereby release, discharge and agree to save harmless the photographer, his representatives, assigns, employees or any person or persona, corporation or corporations, acting under his permission or authority, or any person, persons, corporation or corporations, for whom he might be acting, including any firm publishing and-err distributing the finished product, in whole or in part, from and against any liability as a result of any distortion, blurring, or alteration, optical illusion, or me In composite form, either intentionally or otherwise, that may occur or be produced In the taking, processing or reproduction of the finished product, its publication or distribution (if the same, even should the same subject me to ridicule, scandal, reproach, scorn or indignity.

I hereby warrant that I am over twenty one (21) years of age, and competent to contract in my own name in so far as the above is concerned.

I have read the foregoing release, authorization and agreement, before affixing my signature below, and warrant that I fully understand the contents thereof.

Dated :

Name:

Address:

Phone and E-mail:

Witness:

Address:

Phone and E-mail: