I hereby grant Hippie Skivvies LLC and parties designated by it the irrevocable right to use my photograph or likeness of me in photographs taken of me for web site usage, advertising, ad display and editorial use, without restrictions as to changes, alterations and/or distortions. I fully release these parties from any and all claims and causes of action that I may have now or in the future relating to my voluntary submission of photos of myself, including and without limitation, claims for libel or invasion of privacy. I am not being compensated by anyone for this and am submitting photos of myself for the sole enjoyment of seeing my likeness used by Hippie Skivvies LLC. I have read this release and fully understand its content. I affirm that I am over 18 years of age.

Name: ______________________________________

Address: ____________________________________


E-mail: ______________________________________

Signature: ________________________Date: _______

Send with photo(s) to:         Hippie Skivvies LLC
PO Box 203
Grover Beach, CA 93483

Phone: (805) 904-6138
Fax : (805) 544-7799