I hereby grant the State of Connecticut permission to use my name, image and likeness in a photograph in any and all publications and media associated with the 375th anniversary celebration of the State of Connecticut, including web site entries, without payment or any other consideration in perpetuity. I understand and agree that these materials will become the property of the State of Connecticut and will not be returned. I warrant that I possess all rights necessary for such grant and agree to indemnify the State of Connecticut for any and all claims arising out of a breach of the foregoing warranty.

I hereby irrevocably authorize the State of Connecticut to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing, advertising, exhibiting and exploiting programs involving or associated with the 375th anniversary celebration of the State of Connecticut or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph.

I hereby hold harmless and release and forever discharge the State of Connecticut from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I am 18 years of age or older and am competent to contract in my own name. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release. I agree to indemnify and hold the State of Connecticut harmless for any and all losses, claims, expenses, suits, costs, demands and damages or liabilities on account of personal injury, death, or property damages of any nature whatsoever and by whomsoever made, arising out of the photographed activities in which I am taking part.

I agree