SCHOLARSHIP RECIPIENT WAIVER AND RELEASE Julia F. Thompson, Inc.

(JFT), Mu Kappa Omega Chapter of Alpha Kappa Alpha Sorority, Inc. (MKO), and/or representatives of the local media may want to interview, photograph, videotape, or audiotape scholarship recipients for any lawful purpose, including but not limited to highlighting student achievement(s) or providing general information about scholarship recipients or promoting JFTs scholarship program. The foregoing may also include publishing photos/videos/audios/interviews of the scholarship recipients on the internet, including but not limited to the JFT website and the Pink On The Green Golf Tournament website. As a condition of receiving a 2014 Scholarship from JFT, the undersigned, _____________________________________, hereby acknowledges and hereby gives MKO and/or JFT permission to use any interviews, photographs or video/audio recordings of the undersigned without any prior review and for any lawful purpose. This Waiver and Release remains in effect for 2013 2019 calendar years. The undersigned understands that this Waiver and Release contains the entire agreement between MU KAPPA OMEGA CHAPTER OF ALPHA KAPPA ALPHA SORORITY, INC., ITS OFFICERS AND MEMBERS and JULIA F. THOMPSON, INC., ITS DIRECTORS, OFFICERS, MEMBERS AND/OR AGENTS and the undersigned concerning the above referenced matter, and acknowledge that the terms of this Agreement are contractual and not a mere recital. This Agreement shall be governed and interpreted in accordance with the laws of the State of Texas, without reference to the choice of law principles thereof. I certify that I am eighteen years of age or older and acknowledge that I have carefully read the foregoing Waiver and Release and know and understand the content thereof, and I sign as my own free act.

__________________________________ (Signature of Recipient or Parent/Guardian if under 18) __________________________________ (Print Name) __________________________________ (Date)