I hereby grant this organization permission to use my likeness in a photograph in any and
all of its publications, including website entries, without payment or any other consideration.
I understand and agree that these materials will become the property of the Department of Labor
and will not be returned.

I hereby irrevocably authorize this organization to edit, alter, copy, exhibit, publish or
distribute this photo for purposes of publicizing this organization’s programs or for any
other lawful purpose. In addition, I waive the right to inspect or approve the finished product,
including written or electronic copy, wherein my likeness appears. Additionally, I waive any right
to royalties or other compensation arising or related to the use of the photograph.

I hereby hold harmless and release and forever discharge this organization from all claims,
demands, and causes of action which I, my heirs, representatives, executors, administrators, or any
other persons acting on my behalf or on behalf of my estate have or may have by reason of this
authorization.