In consideration of my engagement as a model, upon the terms hereafter
stated, I do hereby irrevocably authorize David B. Stevens (Webmaster) of 9B
Eatoncrest Dr., Town of Eatontown, County of Monmouth, State
of New Jersey, his legal representatives, assigns, and those acting
under his permission and on his authority to copyright, publish,
and use in all forms and media, and all manners for advertising,
trade, promotion, exhibition, or any lawful purpose whatsoever, still, multiple, or moving photographic portraits or pictures of me
in which I may be included in whole or part, or composite, or
distorted in character or form, in conjunction with my own or fictitious
name, or reproductions thereof in color or otherwise, or other
derivative works that are made through any medium.
I hereby release and agree to hold harmless, David B. Stevens (Webmaster),
his legal representatives, assigns, and all persons acting under his
permission or authority, from any liability by virtue of blurring,
distortion, alteration, optical illusion, or use in composite form whether
intentional or otherwise, that may occur or be produced in the taking
of the pictures, or in any processing tending toward the completion
of the finished product, unless it can be shown that they and the
publication thereof were maliciously caused, produced, and
published solely for the purpose of conspicuous ridicule, scandal,
reproach, scorn, and indignity.
I hereby waive any right that I may have to inspect or approve the
finished product or the advertising or other copy that may be used
in connection therewith or the use of which it may be applied.
I do hereby warrant that I am of full age and have every right to
contract in my own name and in the above regard. Further, I have
read the above authorization and release, prior to its execution,
and I am fully familiar with the contents thereof.
Signed: ______________________________ Date____________
Witness:______________________________
Date____________