Personnel Release
(Consult Your Attorney Before Using)

Date:_________________________
To: __________________________


Gentlemen,
I hereby grant to you permission and consent to photograph, (by video photography or still photography and with or without sound track) my image, voice and name for use in a promotional video described as follows:
 _____________________________________________________
____________________________________________________ _
and to use such images and recorded sounds in the exhibition, advertising, editorial use and publicizing thereof as you, your assigns, successors, and licensees may elect. I affirm that I am more than__________ years of age.
(The age of consent in your state)

Very truly yours,
_____________________________ (Name)
_____________________________ (Address)
_____________________________ (City, State, Zip)