PERSONAL RELEASE Name: _________________________________ Address: _______________________________ ______________________________________ ______________________________________ Phone #: ______________________________ E-Mail: _________________________________ PICTURE: I Cant Believe

Im Still Single Doc Film PRODUCTION COMPANY: Still Single Productions, Inc. th 127 W. 96 Street, Suite D New York, NY 10025 Phone: 310.823.3432 Fax: 310.861.9093 E-mail: StillSingle@terencemichael.com

In full and complete consideration of my appearance in the Picture and/or in the promotion thereof, and without any further consideration due from you or any third party to me, and with the understanding that you in your sole discretion may choose whether or not to include me in the Picture, I hereby agree that you may tape and photograph me and record my voice and conversation (the Performance). I agree that you shall be the exclusive owner of all copyright and other rights in and to such taping, photography and recording (which rights shall include, but are not limited to, the right to edit, modify, add to and/or delete from the Performance, change the sequence of events or of any questions posed and/or answers), and will be able to use them forever in perpetuity and throughout the universe, and to license others to use them, in any manner you wish and in any and all media now known or hereafter discovered or developed. I further consent to your use of any written materials, works of art, still photos, film clips, and/or home videos or movies or videos (the Personal Materials) provided to you by me and I agree that all of the rights and releases given by me in this release shall also apply to the Personal Materials. I further agree that you may use and license others to use the Performance, or excerpts therefrom, and my name, voice, likeness and any biographical facts which may have been provided to you in the Picture, and in any related or derivative versions and/or uses of the Picture (including, without limitation, any serialization(s), translations(s), and/or adaptations(s) thereof), and in the advertising, marketing and promotion of the Picture and production company and its assigns in all media. I confirm that, to the best of my knowledge, any statements made by me during the Performance will be true and will not violate or infringe upon any third partys rights and that your exercise of the rights granted herein shall not violate or infringe any rights of any third party. I hereby release, indemnify, and discharge you, and your assignees and licensees, of and from any and all claims, demands, or causes of action that I may have against you, whether for libel, violation of my right of privacy, claims of fraud, infliction of emotional distress, defamation, or any other matter arising out of or in any manner connected with the use and exercise of the rights granted you herein. I affirm that neither I nor anyone acting for me gave or agreed to give anything of value to any member of your production staff, anyone associated in any manner with your company, or any representative of any television network or station for your undertakings hereunder. I understand your policy prohibits such payments, and I further understand that it is an offense, unless disclosed to you prior to broadcast, for any such arrangement or my acceptance or agreement to accept anything of value to promote any product, service or venture on the air. I am also aware that it is a offense to use any prepared material containing such a promotion where I know the writer received consideration for it and fail to disclose this to you prior to broadcast. I shall notify you immediately if any person attempts to induce me to violate the foregoing or to do anything dishonest. I warrant to you that I am at least 18 years of age and have the full, complete and unrestricted right and authority to enter into this agreement. I shall not directly or indirectly issue or permit the issuance of any publicity whatsoever with respect to the Picture, my appearance in connection therewith, or the material which is the subject of the segment. I shall not use the name of the Picture in any way at any time without your prior written approval in each instance. I further agree that you shall have no obligation to produce and/or broadcast any program using the Performance, or to depict or portray me in any particular manner in the event the company does produce the Picture. I understand that Still Single Productions, Inc. is relying on the foregoing permission and release, and will incur substantial expense in reliance thereon. This Release expresses the entire understanding between myself and you and no other agreements, whether written or oral, have been made. SIGNATURE: ___________________________ PRINT NAME: __________________________ TEL and EMAIL ____________________________________________________