RELEASE 

I, ____________________________, do hereby grant Accu Weight-Loss System, Inc., AccuQuest Health Programs, Inc., and their respective affiliates, agents and assigns (collectively, “Grantee”) an irrevocable, unrestricted, royalty-free right and license to use, reproduce, display, adapt, modify and/or distribute, my name and likeness, including, without limitation “before” and “after” photographs, and any testimonials provided by me with respect to Accu Weight-Loss® “The Bead Diet”® or any other program or service provided by Grantee, in all forms and media (including, without limitation, via the Internet) and in all manners, for Grantee’s marketing and promotional efforts and all other lawful purposes.  I waive any right to inspect or approve the finished versions, including written copy that may be created in connection therewith.  I understand that I will not be paid at any time for the use of any images, information or other media provided by me, and no representation to the contrary has been made to me.   

I have read this release and am fully familiar with its contents. 

Print Name:                                                                 

Signature:                                                                      

Address:                                                         _________

                                                                        _______     Date:                                

Consent   (If the subject is under the age of 18, the parent or guardian must then sign the consent): 

I am the parent or guardian of the minor named above and have the legal authority to execute the above release.  I approve the foregoing and waive any rights in the works describe above. 

Parent or Guardian Name:                                                                  

          Signature:                                                                       

Address:                                                         __________

                                                                        ________    Date:                                

1495598 v1/NY