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Date: _________________


I, (print name) hereby grant permission to ____________________________, to take and use: photographs
and/or digital images of _______________________________, taken by me, for
_____________________________ use.
These materials might include printed or electronic publications, Web sites or other electronic communications. I
further grant permission that my name and company may be revealed in descriptive text or commentary in
connection with the image(s). I authorize the use of these images without compensation to me. All negatives,
prints, digital reproductions shall remain the property of Cory Larsen and Larsen Studios, LLC. This agreement
expires _____________________________.

(City, State, Zip)