I being duly sworn, state that the following information is true and accurate:

In consideration of my participation in the U.S. Cellular® "Life Rewarded Tour Photo Mosaic" Promotion (the "Promotion"), I for myself, my heirs, executors, administrators and assigns, hereby grant to U.S. Cellular, their respective subsidiaries, affiliates, authorized agents/representatives, distributors, advertising agencies and promotional agencies the irrevocable right, without limitation, to use and publish my name (or any fictional name), address (city and state), picture, portrait, image, photograph, video footage, or other likeness and/or voice as well as video and text of any interview or comment I may give in participation with the Promotion (referred to collectively as the "Promotional Materials") for advertising or promotional purposes in any and all media worldwide without limitation, further payment, consideration or notice. I waive the opportunity and right to inspect or approve any such advertising or promotional materials.

In consideration of my participation in the Promotion, I for myself, my heirs, executors, administrators and assigns, hereby agree to release and hold harmless U.S. Cellular and each of their respective officers, directors, employees, agents, successors and assigns from and against any and all actions, suits, claims, losses and demands of any kind whatsoever which I, my heirs, executors, administrators and assigns had, now have, or hereafter may have by reason of any matter arising from or in connection with the Promotional Materials or my participation in the Promotion.

I also agree to indemnify and hold harmless U.S. Cellular, their respective subsidiaries, affiliates, authorized agents/representatives, distributors, advertising agencies and promotional agencies from and against any and all actions, suits, claims, losses and demands of any kind whatsoever which any other party may have with regard to the Promotional Materials.

I warrant and represent that I have read or have had read to me and understand all the provisions of this Release and agree to be bound by all of them.

I warrant and represent that I have the right and power to enter into and to perform this Release.

I warrant and represent that the Promotional Materials are original and not obscene or defamatory and that none of the Promotional Materials infringe any third party rights.