I hereby waive any right to inspect or approve the photographs, video or the advertising copy or printed matter that may be used by Winter Publishing in conjunction herewith, and further waive any claim that I may have to the eventual use to which it may be applied. Such photographs or video may be used in the sole discretion of Winter Publishing with my name or a fictitious name, and with fictitious or accurate biographical information.

I hereby release, discharge and agree to save harmless Winter Publishing from and against any and all liability in connection with the use of such photographs or video and from any liability as a result of any distortion, blurring or alteration, optical illusion or use in composite form, either intentionally or otherwise, that may occur or be produced in the taking, processing or reproduction of the finished product, or its publication or distribution, even should the same subject me to ridicule, scandal, reproach, scorn or indignity.

I hereby verify that I am 18 years of age or older and have read the authorization and release prior to its execution. I have not been induced, other than by the consideration received, if any, to execute the same by any representation or statement made by the photographer or videographer or his/her agents, employees, or any one acting on his/her behalf.

____________________________________________________________________________ signature date date of birth

____________________________________________________________________________ Model’s Name (please print)

____________________________________________________________________________ Aliases Used Previously

____________________________________________________________________________ Address

___________________________________________________________________________ City, State, Zip

____________________________________________________________________________ Witness date

In addition to the above signed release, two forms of I.D., photocopied, are required. One must have a photograph (Column A) and the second must have a name that matches the photo I.D. from Column A.

COLUMN A (must have photo)

COLUMN B (must be in model’s name)