PERMISSION and RELEASE

Fifty Eggs, LLC

PO Box 81005
Wellesley Hills, MA 02481

Ladies and Gentlemen:

You have requested that I appear in a film and multi-media project which Fifty Eggs LLC is producing,
wherein my voice, name, likeness, photographs, performance, words and actions (collectively,
"Performance") as well as photographs, video clips, film footage, newspaper clippings, letters, business
plans, or other such images owned by me ("Images") may be used in that film and multi-media project and
in other materials which may be produced in connection or conjunction with the film, including without
limitation, promotion and publicity (collectively, the "Program")

In consideration of my inclusion in the Program and for other good and valuable consideration including a
video copy of the Program, the receipt and sufficiency of which are hereby acknowledged, I agree that you,
your employees, licensees, successors, heirs, assigns, and any persons or entities with whom Fifty Eggs
LLC and their affiliates and subsidiaries are working (collectively, "Affiliated Entities") shall have the non-
exclusive, irrevocable right to use my Performance and Images in connection with the Program, in all
media, in all formats, worldwide, in perpetuity, including promotion and publicity of the Program, or in
connection with any other project produced by Fifty Eggs LLC.

I release, waive and discharge Fifty Eggs LLC and the Affiliated Entities, for any and all claims, demands,
and causes of action of whatever kind or nature, at law or in equity, whether now existing or hereafter
arising (including those based upon libel, defamation, and invasion of privacy) relating in any way to the
Performance, the Images, or the Program.

I acknowledge that I have not and will not receive any payment or consideration from you other than that
set forth herein. I represent and warrant to you that I have the unencumbered right to enter into this
agreement, and acknowledge that you shall not be obligated in any way whatsoever to use the rights
granted to you herein.

Executed under seal as of this day of _________, 2010.

_____________________________
(Name – signature)

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_____________________________
(Address)

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(Telephone No.)

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(Email Address)