I / we hereby grant to Lednor Corporation (dba Gutter Helmet Systems), its legal representatives and assigns, those for whom Lednor Corporation (dba Gutter Helmet Systems) is acting, and those acting with its authority and permission, the absolute right and permission to copyright and use, publish, reproduce in any form and fashion, my photographic, taped (video and /or audio), filmed, synchronized sound and visual likeness and performances, and that of my home and property, whether or not posed and whether by name or fictitious name, testimonial of public copy which constitutes endorsement, and used in connection therewith for publication and advertising of any kind or character. I am at least 18 years of age.

This release shall extend to all forms of commercial production. Any right to inspect or approve any photograph, print, or reproduction is waived.

NAME: _____________________________________________________________

ADDRESS: __________________________________________________________

CITY: ________________________________ STATE: _____________ ZIP: _______

HOME PHONE: ___________________ DAYTIME PHONE: ___________________

TELL US ABOUT YOUR GUTTER HELMET SYSTEMS EXPERIENCE: ____________
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SIGNATURE: _____________________________________ DATE: ______________