Consent to Photograph /Videotape / Interview Individuals Please read, date, and provide your signature on the next pages Terms & Conditions

I hereby agree and give my permission for Urban Matrix Mall and/or partners to record, film, photograph, audiotape, or videotape myself (hereinafter collectively referred to as “Works”) and to display, publish or distribute these Works for the purpose of publishing, posting on the Urban Matrix Mall and Urban Matrix Magazine websites and posting on social media sites. I hereby waive any right to approve the use of these Works now or in the future, whether the use is known to me or unknown, and I agree to negotiate fair terms in regards to any royalties related to the use of these Works. I understand that the Works may appear in electronic form on the internet or in other publications outside of the Urban Matrix Mall's control. I agree that I will not hold the Urban Matrix Mall responsible for any harm that may arise from such unauthorized reproduction.