IMAGE RELEASE FORM

I hereby grant to Nicros, Inc., Vertical Endeavors, Inc., Vertical Endeavors– Duluth, Inc., Vertical Endeavors–Glendale Height, Inc., Vertical Endeavors-Minneapolis, Inc., Vertical Endeavors-Bloomington, Inc., Vertical Endeavors- Twin Cities- Bouldering, Inc., its subsidiaries, affiliates, licensees, successors and assigns, the right to photograph me and use my name and likeness for any legitimate business purpose, including but not limited to publicity, promotion and advertising. This grant shall extend to any and all reprints and reissues of any such photographs.

Your Name (first & last) *

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—Please choose an option—BloomingtonDuluthGlendale HeightsMinneapolisSt. PaulTwin Cities Bouldering

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Parent E-Signature (if releasee is under 18)**

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