VIDEO STIPEND RECEIPT

I, (print name)_______________________________ certify that I have agreed to

participate in a video shoot produced by HF Industries on behalf of their client
(MORE Advertising) for The Commonwealth of Massachusetts Department of
Public Health.

By agreeing to participate in this activity, I understand that I will receive a one-

time stipend in the amount of $225.00 US (two hundred twenty five dollars and
00/100).

This stipend represents the total pay-out for this project.

________________________________ ________________________

Signature Date

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