In consideration of my engagement as a model, and for the other good and valuable consideration herein acknowledged as received, upon the terms hereinafter stated, I hereby grant I-candy Multimedia/NBZ Design, there legal representatives and assigns those for whom __________________________ is acting, and those acting with there authority and permission to copyright and use, re-use and publish, and re-publish photographic portraits and video content of me or in which I may be included, in whole or in part, or composite or distorted in character or form, without restriction as to changes or alterations, from time to time, in conjunction with my own or fictitious name, or elsewhere for art advertising, trade or any other purpose whatsoever.

I also consent to the use of any printed or electronic matter in conjunction therewith.

I hereby waive any right that I may have to inspect or approve the finished product or products or the advertising copy or printed matter that may be used in connection therewith or the use to which it may be applied.

I hereby release, discharge and to save harmless I-candy Multimedia/NBZ Design, there legal representatives or assigns, and all persons acting under there permission or authority or those for whom they are acting, from any liability by virtue of any blurring, distortion, alteration, optical illusion or use in composite form. Whether intentional or otherwise, that may occur or be produced in the taking of said picture/video or in any subsequent processing thereof, as well as any publication thereof even though it may subject me to ridicule, scandal reproach, scorn, and indignity.

I hereby warrant that I am of legal age and have every right to contract in my own name in the above regard. I state further that I have read the above authorization, release and agreement, prior to its execution, and that I am fully familiar with the contents thereof.


Dated:______________________ On this date I am _____ Years of age


Modelís Signature_____________________________


Driverís License State:______ #__________________

Full Name Printed _____________________________

Name you wish to use _____________________________

Additional Comments _______________________________________________


Please fill out entire form and attach a xerox copy of your Driver's License / State issued ID card to the back of this form and mail, along with a few photos of yourself, to:


686 S Arroyo Pkwy Suite #22 Pasadena, Ca 91105