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City and State

FOR GOOD AND VALUABLE CONSIDERATION, the receipt whereof is hereby acknowledged, I do hereby irrevocably authorize ITNAmerica, a Maine non-profit corporation ("Company"), to create, record, produce, use, reproduce, modify, distribute, publish, perform, display and transmit images and recordings either (i) made by me or (ii) in which my name, identity, biographical information, voice, likeness, photograph, image and persona, and any statement of which I am an author, whether or not written or otherwise recorded, or portion thereof (collectively, the "Materials"), appears or is captured, in whole or in part, in any form or media, whether now known or hereafter developed, including without limitation print media, social media and Internet broadcast and display, at its sole discretion, without restriction as to changes or alterations. I understand that, based on space or other considerations, the Materials may be modified or edited before use, or may not be used. 

I authorize Company to use my name, picture, and excerpts from the Materials for promotional purposes consistent with the permitted uses described above. I hereby forever release and agree to indemnify and hold harmless Company from and against any and all claims arising from the use of the Materials as described above. 

I have read and understand this document. I waive all rights to compensation for the use of the Material by Company, and understand that Company will have sole authority over use of the Materials.