A.V. MAPPING CO., LTD Media Authorization & Release Form — Attendee

I, (print name) ________________________ authorize A.V. Mapping Co., Ltd. and its employees or agents (collectively, “AV”) to take photographs, motion pictures and/or audio recordings of me. I agree to my image, voice, submitted video productions, and/or likeness being used in all forms of print and electronic media recordings and publications and/or audio or video productions for purposes related to the FAIM Festival of AV, including all FAIM Festival events and the publicity, marketing and promotion of FAIM Festival for AV (the “Material”). I acknowledge that AV will be the copyright owner of the Materials and my image, voice, submitted video production and/or likeness becomes the sole and exclusive property of AV, and that AV may sell, copy, modify, create derivatives, license, assign, transfer, archive and otherwise use my image, voice, submitted video production and/or likeness in any Material. I release AV from any and all liability arising out of the use of my image, voice, submitted video productions, and/or likeness, including without limitation any claims arising out of my right of privacy or right of publicity. I am participating on a voluntary basis and no compensation, fees or royalties will be paid for this use.

______________________________ ______________________Signature Date

_____________________________________________________ Address City/State/Zip

If the participant is under age 18, the parent or guardian must also complete the following:

I am the parent or guardian of the person whose image or voice may appear in the Materials and I give my consent and authorization as set forth above.

______________________________ ______________________Signature of Parent/Guardian Date

_______________________________________________________ Relationship

___________________________________________________________________Address City/State/Zip