MODEL RELEASE FORM

Print out the following form, sign it and fax or mail it to Jones Soda Co. We cannot use your likeness for labels on our beverages without this signed model release form.

JONES SODA LABELS
234 Ninth Avenue North
Seattle, WA 98109
P: 206.624.3357
F: 206.624.6857

I, ____________________________, hereby grant Jones Soda Co. an irrevocable license to use me likeness as attached in the enclosed photograph(s) now or at any time in the future, throughout the world in any manner it so chooses and in any medium now known or later developed. This includes, without limitation, use on Jones Soda or Jones Naturals labels, carrier packs, magazine advertisements, corporate brochures and any other promotional material it wishes. I acknowledge that Jones Soda Co. is under no obligation to use my likeness.

I agree that there are to be no fees, commissions or royalties paid to me for the use of my likeness.

I acknowledge and agree that I have the exclusive right and authority to grant this license to use my likeness.

Jones Soda Co. is not responsible for lost or damaged photos.

Please PRINT the following information. Be sure to include your signature at the bottom.

Name ____________________________________________________________

Address ___________________________________________________________

City _______________________________________________________________

State ____________________________    Zip  _____________________________

E-Mail Address _______________________________________________________

Telephone ___________________________________________________________

Gallery Photo # (if applicable) ____________________________________________

Photographer’s Name __________________________________________________

Description of Photo ___________________________________________________

Signature ____________________________    Date  _________________________

Parent/Guardian Signature (in case of minor) _________________________________