For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, MODEL NAME, who resides at MODEL'S ADDRESS (the "Releaser"), hereby gives, consents, and forever grants to YOUR NAME, with a place of business located at YOUR ADDRESS ("Manufacturer"), its representatives, licensees, marketers, and any other related parties or publishers of its promotional materials and their successors and assigns, the right to use, publish and copyright my picture, portrait or likeness, in whole or part, including alterations, modifications, derivations, and composite thereof, in advertising and promotions throughout the world. This right shall include the right to combine my likeness with others and to alter my likeness by digital or other means.

Releaser also hereby releases Manufacturer and such other parties from any obligation to make any payment hereunder or from any other liability incurred in connection with the use of any the materials described above. Releaser acknowledges his or her full and complete satisfaction with the terms of this Release.