hereby grant to Colaberry Inc ( “Colaberry” ) and its successors, and assignees the right to
record my image and/or voice and use artwork and/or written work, on videotape, on film, on
photographs, in digital media and in any other form of electronic or print medium and to edit
such recording at their sole discretion for the purpose of Colaberry’s research and marketing.
I further grant Colaberry, its successors, and its assignees the right to use, and to allow
others to use my image and/or voice on the internet, in brochures, and any other medium and
hereby consent to such use.
I hereby release Colaberry and its successors, and assignees, and any others using my image
and/or voice, artwork, and/or written work pursuant to this media release form from any and all
claims, damages, liabilities, costs, and expenses which I now have or may hereafter have by
reason of any use thereof.
I am 18 years of age, and I am competent to sign this release in my own name. I have read the
foregoing and fully understand the meaning and effect thereof and, intending to be legally
bound, I have signed this release voluntarily and without reservation.
I understand that the provisions of this release are legally binding.
I understand that I can revoke this consent by sending the notification to