|
MODEL'S RELEASE
FOR
VIDEOTAPED MATERIALS and PRODUCTIONS and or Pictures Submitted
Model 's Full Name____________________________________________________________
Address____________________________________________________________
City__________________________________State
___________ Zip ___
____________________
Telephone (home)
____________________
Telephone (work)
I
hereby give____________________________
(Videographers Name)
his / her successors and
assigns, the absolute right
and permission to copyright, and or use my pictures, videotaped material in whole or in part, composite or distorted in character
or form, in conjunction with my own or a fictitious name, with reproduction thereof in color or otherwise, made through any
media at any studio or elsewhere, for an, advertising, trade or any other lawful purpose whatsoever.
I hereby release,
discharge and agree to save_______________________________.
Videographers Name
his / her successors, assigns, and
agents from all liability in connection with the copyright or distribution of my pictures, videotaped material and or model
information pertaining to me.
I hereby waive any right that I may have to inspect and or approve the finished video
production, audio track, and printed matter that may be used in connection therewith, or the use to which it may be applied.
I
hereby represent that I am over the age of 18 years and I have read this authorization and release prior to its execution.
I have not been coerced to execute this release.
Signature___________________________________________________
IMPORTANT:
To show that model's signature is genuine it must be notarized.
STATE OF_________________________________________________
County
of_____________________________
On this _______day of________________19______Before me personally
appeared _____________________________
known to me to be the person executing the foregoing release he / she executed the same for the purposes therein stated.
NOTARY
PUBLIC
An Enrichment of Common Benefit Between Nations
|
