Grant

For consideration which I acknowledge, I consent to the recording of my statements and grant to Nicole Chamblin dba Visions Productivity Solutions ("Company") and Company's assigns, licensees and successors the right to copy, reproduce, and use all or a portion of the statements (the "Interview") for incorporation in the following work Organizing & Personality Book Project (the "Work").

I permit the use of all or a portion of the Interview in the Work in all forms and media including advertising and related promotion throughout the world and in perpetuity. I grant the right to use my image and first name in connection with all uses of the Interview/Assessment and waive the right to inspect or approve use of my Interview/Assessment as incorporated in the Work.

Release

I release Company and Company's assigns, licensees and successors from any claims that may arise regarding the use of the Interview including any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity or copyright. I acknowledge that I have no ownership rights in the Work.

Company is not obligated to utilize the rights granted in this Agreement.

I have read and understood this agreement and I am over the age of 18. This Agreement expresses the complete understanding of the parties.

Name: ____________________________________________ Date: ____________________

Signature: __________________________________________________________________

Address: ___________________________________________________________________

Please print and fax signed agreement to 516-977-2287 attention Nicole Chamblin, Visions Productivity Solutions.