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Photographer Info
Name
*
First
Last
Model Info
Name
*
First
Last
Layout
Phone
*
Email
*
Address
*
Address Line 1
Address Line 2
City
--- Select state ---
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State
Zip Code
Consent and Authorization
*
I hereby grant permission to the photographer named above to photograph me during the photography session.
I hereby warrant that I am eighteen (18) years old or more and competent to contract in my own name.
I hereby warrant that I understand that my images will be sent to 3rd Party printing shops if I purchase any physical media
Waiver and Release
*
I hereby warrant that I understand that these images may be used for promotional purposes if I sign the additional 'Media Release Form'
I release the photographer from any liability for damages or injuries incurred during the photography session.
Digital Signature
*
Date of Agreement
*
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