Smoke Free Set Your Date Series
Application Release Agreement

I, the adult applicant listed above, in connection with my application to be considered as a participant in Smoke Free's Set Your Date Series Testimonial Campaign, represent and warrant that the information provided by me to the foregoing application is true, complete and correct, that I have voluntarily completed this application honestly and accurately and I understand, acknowledge and agree that if any of the information in this application is found to be false or incomplete, this will be grounds for dismissal from the participant selection process . I acknowledge that The University of Texas at El Paso and/or the Laster Group may or may not select me for further consideration to be part of the Testimonial Campaign at their sole and absolute discretion.

I acknowledge and agree that if I am selected for further consideration, I will be required to complete and sign additional application materials, release forms and other documents. The University of Texas at El Paso and/or the Laster Group may use the information in this form for any purpose at their sole discretion, including making such information public as part of the Testimonial Campaign.

By signing below, in connection with my application to participate in the Testimonial Campaign, I hereby acknowledge, represent and warrant that (1) The University of Texas at El Paso and/or the Laster Group have no obligation to interview me and/or select me as a participant and may choose participants at its sole and absolute discretion; (2) I agree to keep all information about the testimonial campaign that I acquire during the participant selection process and/or my participation in the testimonial campaign strictly confidential; (3) My name, voice, actions and likeness may be recorded on audiotape, videotape or otherwise as a part of this application and participant selection process; (4) I understand that regardless of whether I am actually selected to participate in the testimonial campaign, The University of Texas at El Paso and/or the Laster Group are in no way obligated to, but at their sole discretion may, use such recordings and the contents of this application within or in connection with the Testimonial Campaign, including, without limitation, in advertisements, promotions, publicity, marketing, merchandising or in any other manner, in any and all media now known or hereafter devised, worldwide in perpetuity.

If I am selected as a participant, The University of Texas at El Paso and/or the Laster Group have no obligation to broadcast or exploit the testimonial campaign; all decisions by The University of Texas at El Paso and/or the Laster Group concerning selection of participants and all other matters relating to the Testimonial Campaign are final and not subject to challenge or appeal; and The University of Texas at El Paso and/or the Laster Group have no obligation to return any materials submitted by me (including without limitation to this application, any documents, photographs and videotapes submitted by me) as part of the participant selection process whether or not I am selected as a participant, and The University of Texas at El Paso and/or the Laster Group may, but are in no way obligated to use any such materials in and connection with the testimonial campaign, including, without limitation, in advertisements, promotions, publicity, marketing, merchandising or any other manner.

By submitting this application, I hereby consent to the recording, use and reuse by The University of Texas at El Paso, The University of Texas System, the Laster Group and any of their respective consultants, contractors and affiliated entities and each of their respective employees, contractors, agents, officers, directors, and Regents (collectively "Releases") of my voice, actions, likeness, name, appearance, biographical material and any information contained in or derived from my application to be a participant in the testimonial campaign, including, without limitation, any photos or videotapes submitted by me, editorial comments made by me or about me, and any audio, video or other recordings or still pictures of me taken during the participant selection process or contained in any materials or documents submitted by me in connection with my application (collectively "Likeness") as such may be edited, altered or modified by The University of Texas at El Paso and/or the Laster Group or any of the Releases at their sole discretion, in any and all media now known or hereafter devised, worldwide in perpetuity, in or in connection with the testimonial campaign, including, without limitation, in advertisements, promotions, publicity, marketing, merchandising, or in any other manner. I agree that the Releases may use all or any part of my Likeness, may alter or modify it regardless of whether or not I am recognizable. I further agree that Releases exclusively own all rights, title and interest (including, without limitation, all copyrights) in and to any recordings made by any of the Releases as well as any video that I have provided in connection with my application and any other materials that I have provided or may provide in connection with the testimonial campaign (the "Materials") including, without limitation, the right to edit, alter or modify the Materials and to use all or part of the Materials and my Likeness in any manner and in any and all media now known or hereafter devised worldwide, in perpetuity.

I grant the rights hereunder whether or not I am selected to participate in the testimonial campaign in any manner whatsoever. I release, hold harmless, and indemnify Releases from any and all liability arising out of their recording or use of my Likeness and/or the Materials (including, without limitation, any claim that such use defames me or invade any right of privacy and/or publicity). By signing this application, to the maximum extent permitted by law, I hereby release, hold harmless and indemnify The University of Texas at El Paso, the Laster Group and all other Releases and any television station or channel, cable network or satellite network that exhibits the testimonial campaign. I understand that the selected participants for the Testimonial campaign will be selected by a panel of Smoke Free professionals based on who of the entrants has come closest to their predetermined goal. I understand that neither I nor anyone else will be paid for my granting the above rights, or for my signing this agreement. My participation in the process for the Testimonial Campaign itself does not constitute a performance and will not entitle me to wages, salary, or other compensation. I agree and acknowledge that no one (including but not limited to The University of Texas at El Paso, the Laster Group, The University of Texas System or their affiliates, board members, officers or Regents) has asked me for any money or other consideration to be considered for participation in the Testimonial Campaign. I have signed or do sign in connection with my application to be selected as a participant in the testimonial campaign, or any other written or oral statements I make in connection therewith and hereby waive all rights of privacy or confidentiality that I might otherwise have in such information. I acknowledge and agree that any such information obtained by The University of Texas at El Paso and/or the Laster Group pursuant to this paragraph or otherwise maybe used for purposes of selecting participants in the testimonial campaign, and may be described or otherwise related in and in connection with the campaign, including, without limitation, in advertisements, promotions, publicity, marketing and merchandising, and in any other manner.

I release The University of Texas at El Paso, the Laster Group and those acting pursuant to their authority from liability for any violation of any personal or proprietary right I may have in connection with the above identified uses. This release is executed gratuitously and/or for any self-satisfaction which I may derive from any publication or programs in which my likeness or voice will appear. I understand that all such recordings, in whatever medium, shall remain the property of The University of Texas at El Paso and the Laster Group.

I understand the referral fee of $100.00 USD, shall be paid directly to the individual who referred me to submit this application. I understand that there is no compensation paid for direct or self-referrals. I understand that in order for the person who referred my to submit my application to be compensated I must indicate that person on my application at the time I submit it, complete with their name, and phone number (email address is optional.

I HAVE READ AND FULLY UNDERSTAND THE TERMS OF THIS RELEASE.