Model Release  (Compensated Adult) b   e   u s s e r y™   imagery co. www.beussery.com    In consideration of _____________________ Dollars ($____________), receipt of which is acknowledged, I, ______________________________, do hereby give Brian E. Ussery, his assigns, licensees, and legal representatives the irrevocable right to use my name (or any fictional name), picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for advertising, trade, or any other lawful purposes, and I waive any right to inspect or approve the finished version(s), including written copy that may be created in connection therewith. I am of full age. I have read this release and am fully familiar with its contents. © beussery™ MMIII. All rights reserved. Witness___________________________________ Social Security Number_______-____-_______ Address___________________________________ Model_____________________________________ Social Security Number_______-____-_______ Address___________________________________ Date ___________, 2003