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AGREEMENT, AUTHORIZATION AND WAIVER FOR USE OF NAME

AND LIKENESS

COMES NOW _________________________________(Actor) and Trans

Lifeline, a California nonprofit corporation, and hereby agree as follows:

1.

Trans Lifeline operates a suicide and crisis hotline designed to serve

members of the transgender community staffed by trans volunteers and

managed by trans individuals;

2. Actor wishes to contribute their name and likeness to promote this effort;

3. Actor affirms that they are over the age of eighteen (18) and have

sufficient legal capacity to enter into this Agreement and Authorization.

If Actor is under the age of 18, Actors parent or legal guardian will need

to complete a separate Agreement before the use of Actors name orlikeness can be considered;

4. In consideration for Trans Lifelines decision to consider using the

Actors name or likeness, Actorhereby grants Trans Lifeline and/or its

agents, assignees, or partners a nonexclusive license to use their name

and likeness as part of Trans Lifelinespromotional efforts. Said

promotional efforts shall include but not be limited to campaigns run by

and for Trans Lifeline and campaigns run through third parties for the

benefit of Trans Lifeline, for example. GiveOutDay.org5.

This license shall include and is intended by the parties to include all

intellectual and other property interests recognized under federal or

California law, including but not limited to those recognized under Calif.

Civ. Code 654. Furthermore, said license shall act as a complete

defense to any claim under Calif. Civ. Code 3344 as well as any claim

of libel, slander or false light under state or federal law;

6.

Actor may revoke the license set forth in 4., above by providing Trans

Lifeline with written notice of such revocation ninety (90) daysin

advance from the effective date of revocation by sending a letter via

certified or overnight mail to the corporations attorney: Ms. Christina

A. DiEdoardo, Esq., Law Offices of Christina DiEdoardo, 201 Spear

Street #1100 San Francisco CA 94105;

7.

If Actor issues a Notice of Revocation as set forth in 5., above, then

Trans Lifeline will use all reasonable efforts to remove Actors name and

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likeness from future promotional efforts and from its Web site and

promotional channels under its control prior to the effective date of

revocation and to not use Actors name and/or likeness in the future

unless a new release is entered into between Actor and Trans Lifeline.

However, Actor and Trans Lifeline agree that Trans Lifeline is notrequired to recall or revise materials using Actors name and/or likeness

which are already in existence prior to the Notice of Revocation.

8.

Actor irrevocably waives any claim for financial compensation relating

to the use by Trans Lifeline of their name and likeness for the purposes

set forth in this Agreement, Authorization and Waiver and agrees to

indemnify and hold Trans Lifeline harmless for any and all claims

associated or which could be associated with its use by Trans Lifeline in

accordance with this Agreement, Authorization and Waiver.

Date:_________ ___________________________________Actor