For and in consideration of my engagement as a model by Steven R. Kok, hereafter referred to as the artist, on terms or fee hereinafter stated, I hereby give the artist, his legal representatives and assigns, those for whom the artist is acting, and those acting with his permission, the right and permission to copyright and/or use, reuse and/or publish, and republish digital fine art pictures or portraits of me, on 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 artist 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 image or advertising copy or printed matter that may be used in conjunction therewith or to the eventual use that it might be applied.

I hereby release, discharge and agree to save harmless the arist, his representatives, assigns, employees or any person or persons, 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/or 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 use 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 of the same.

I hereby certify that I am over eighteen years of age, and competent to contract in my own name in so far as the above is concerned.

I am to be compensated as follows:

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

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Name (Printed)

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Signature

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Current Date

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Date of Birth