Interview and Photography Release

By this Interview and Photography (Release) Halliburton Energy Services, Inc. (Halliburton) hereby grants permission to the News Media Outlet referred to herein as ( Requestor) the right and permission to interview and/or take photographs of certain Halliburton employees who have been preapproved by Halliburton for such interviews and photographs (collectively, referred to as Media Video) in connection Live Well Wyoming. The Media Video is to be used for the purposes contemplated herein, which includes use by Requestor in its news stories. Requestor agrees the Media Video will only be used for the stated purpose, and will not be used for any other purpose or activity in connection with advertising, marketing, promoting or distributing of goods and services, including books, without express written permission of Halliburton. This Release is personal to the Requestor and may not be assigned, sublicensed or transferred by Requestor without express written permission of Halliburton. Requestor agrees to not use the Media Video in a manner which could cause damage, injury or impairment to Halliburton or to portray Halliburton in a negative light. By signing below, Requestor agrees to be bound of the terms of this Agreement. Requestor agrees to release, defend and hold harmless Halliburton, its employees, its agents, and contractors who may have been involved in the Media Video or the subject of the Media Video from and against any claims, damages or liability arising from or related to the use of the Media Video by Requestor. The Requestor should be accompanied by a Halliburton representative at all times, and Requestor agrees to follow health, safety and environmental requirements as necessary, and to restrict the Media Video to any assigned area. This Interview and Photography Release shall be governed by the laws of the State of Texas, United States of America. No representations or warranties of any kind related to the Media Video are made by Halliburton. All warranties, express, implied or statutory, including without limitation all implied warranties of any kind are expressly disclaimed by Halliburton. A signed copy should be returned to the appropriate Halliburton representative. News Media Outlet (Requestor) Name_____________________________________

By: _______________________________________ Name: ___________________________________ Title: ____________________________________ Date: ____________________________________ Address: _________________________________ _________________________________________ Telephone: _______________________________ Email: ___________________________________