Model Release Form - Durango Independent Film Festival printable pdf download

Model Release Form - Durango Independent Film Festival

AUTHORIZATION TO USE AND REPRODUCE PHYSICAL LIKENESS

I, _____________________________, hereinafter MODEL, hereby expressly grant to _________________________,

hereinafter “ARTIST,” and to ARTIST’S employees, agents, and assigns, the right to photograph me and use my

picture, silhouette and other reproductions of my physical likeness in ARTIST’S design of the poster for the 2010

Durango Independent Film Festival. I understand that if the ARTIST’S design is selected as the official 2010 poster

design, my photograph or likeness may appear in promotional materials for the 2010 Durango Independent Film

Festival, and that I, my employees, agents, and assigns will not be entitled under any circumstances to any

remuneration of any sort from the Durango Independent Film Festival, or its employees, agents, partners, vendors, or

volunteers.

Name

Email Address

Address

City, State, Zip

Phone

Alt Phone

Age:

___under 18

___18+

I represent that I am the MODEL, or the parent or legal guardian of the above-named MODEL, and that I have

read and understand the above statements.

_____________________________________________________

________________________

Signature of Artist or Participant’s Parent or Legal Guardian

Date

Model Release Form - Durango Independent Film Festival