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Years at State Farm*

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For adequate consideration, I grant to State Farm Mutual Automobile Insurance Company, its subsidiaries and affiliates (“State Farm®”), unqualified and irrevocable permission to photograph, videotape, or record in any form my image, and my voice as well as to create transcriptions of my voice arising from: All events and I assign to State Farm all rights I may hold in such recordings or transcriptions including, but not limited to, copyrights. I understand and agree that State Farm, at its sole discretion, may use such recordings of my image, or my voice, without restriction, including but not limited to, use in internal materials, promotional materials, audiovisual works, and display by any means including the Internet, at any time in the future. Further, I understand and agree that State Farm may grant third parties unrestricted permission to use said recordings or transcriptions in any non-defamatory manner. Additionally, I grant State Farm unqualified and irrevocable permission to use my name in conjunction with the aforementioned photographs, videotapes, recordings, and transcriptions. I also grant State Farm permission to authorize third party use of my name in conjunction with the aforementioned photographs, videotapes, recordings, and transcriptions. I release State Farm from any and all claims of any kind resulting from the use of the aforementioned recordings and transcriptions of my image, voice, and property including but not limited to, any and all claims of damages for libel, slander, and invasion of the right of privacy. I am of lawful age and have read and understand this General Authorization, Assignment, and Release.

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