Send to: Matthew Brommer Turkey Hill Dairy 2601 River Road Conestoga, PA 17516-9630

In consideration of the receipt of two free Turkey Hill ice cream certificates and for other good and valuable consideration received by me, I hereby give permission to Turkey Hill Dairy and its authorized agents and representatives to use still photographs and or moving pictures of me and/or my child/pet ___________________________________ for application to their Web Site. The terms of this permission will continue for 5 years. I have read this agreement and understand it.

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Name of person in picture (please print)		(Date)

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Signature (parent/guardian if minor)

Mailing Address:    Street: ________________________________________    City: __________________________________________    State: _______________    ZIP Code: _________

Caption information Turkey Hill may want to use:

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