MODEL RELEASE FORM
This Model Release Form relates to the following photographs and/or images (the "Work"):
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I, ________, of legal age, with address at ________, consent, agree and authorize ________, of legal age, and with address at ________ (the "Publisher"), together with any officers, employees, directors, agents, contractors, assignees, licensees, transferees, successors, legal representatives, or other representatives of the Publisher (the "Publisher's Representatives"), to use, publish, reuse, republish, distribute, disseminate, or otherwise make publicly available the Work for any lawful use that the Publisher or any of the Publisher's Representatives determine in their absolute discretion, including the use of my name without restriction. The Publisher shall also be specifically permitted to use fictitious names in conjunction with the Work.
Lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat duis aute irure dolor in reprehenderit voluptate velit esse cillum dolore eu fugiat nulla pariatur lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud exercitation ullamco laboris.
This authorization and release shall inure to the benefit of the legal representatives, licensees, heirs, and assigns of the Publisher and shall be binding upon me, my heirs, assignees, and legal representatives.
Lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat duis aute irure dolor in reprehenderit voluptate velit esse cillum dolore eu fugiat nulla pariatur lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud exercitation ullamco laboris.
Signed this day of ______ day of _____________________, 20______ at the City/Municipality of _____________________, Province of _____________________.
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Model