ADULT MODEL RELEASE: 2257 COMPLIANCE FORM:

Model Name:
Model's Legal Name
All other names ever used,
including married names,
maiden name, stage
names, nicknames, aliases,
etc.


Identification !od"ced: #
$t
fo!m of identification !od"ced %C&oo$e #'
Picture identification card:
Issued by hat government
entity!

"rivers License #number
Pass$ort %number
&tate identification card
%number



'ork Identification card

"ate of (irth of model
Address of model
)ity:
&tate:
)ountry:


Identification !od"ced: 2
nd
fo!m of identification !od"ced %C&oo$e #'
Picture identification card:
Issued by hat government entity!
"rivers License # *
Pass$ort *
&tate identification card
&chool I.". *
&elective service card *
'ork Identification card *
+ther *

TERMS AND CONDITIONS:
I, the undersigned model ,hereafter model- do hereby voluntarily authori.e and give
$ermission to /LP 0en. Part. to the e1clusive use of: $hotogra$hs, video, electronic and
digital re$roductions in any form of my $erson or $ersonal $ro$erty
2rom the date of e1ecution of this 0eneral 3elease and Authori.ation, the undersigned
hereto does hereby grant, release and assign to /LP 0en. Part. any and all claims of
right hatsoever in and to all $hotogra$hs or $rinted materials of the undersigned or by
the undersigned and delivered to /LP 0en. Part. for any $ur$ose chosen by /LP 0en.
Part.
2rom e1ecution hereto and for value received and acknoledged belo by model, /LP
0en. Part. shall e1clusively and irrevocably on in $er$etuity all right, title and interest,
including co$yright, in and to the digiti.ed $hotogra$hs, re$roductions, video and any
digiti.ed $rinted material of the undersigned ith no rights e1$ressly reserved by the
model.
Model also grants /LP 0en. Part. and its designees the right to use her name, likeness,
image voice, a$$earance, and $erformance as embodied in the Product hether recorded
on or transferred to videota$e, film, slides, $hotogra$hs, audio ta$es, or other media, no
knon or later develo$ed. 4his grant includes ithout limitation the right to edit, mi1 or
du$licate and to use or re%use the Product in hole or $art as /LP 0en. Part. may elect.
/LP 0en. Part. or its designee shall have com$lete onershi$ of the Product in hich
model a$$ears, including co$yright interests, and model acknoledges that she has no
interest or onershi$ in the Product or its co$yright. a- the unrestricted right and
$ermission to co$yright and use, re%use, $ublish, and re$ublish $hotogra$hic $ortraits,
video or $ictures of me or in hich I may be included intact or in $art, com$osite or
distorted in character or form, ithout restriction as to changes or transformations in
con5unction ith my on or a fictitious name, te1t or fictitious story line, or re$roduction
hereof in color or otherise, made through any and all media no or hereafter knon for
illustration, art, $romotion, advertising, trade, $rofit, eb media or any other $ur$ose
hatsoever.
I also $ermit the use of any $rinted or electronic or digital broadcast material, that could
be connected ith said media in connection thereith
I hereby relin6uish any right that I may have to e1amine or a$$rove the com$leted $roduct
or $roducts, images, video or te1t advertising co$y or $rinted or digital broadcast matter
that may be used in con5unction thereith or the use to hich it may be a$$lied.
I hereby release, discharge and agree to save harmless /LP 0en. Part. , his7her heirs,
legal re$resentatives or assigns, and all $ersons functioning under his7her $ermission or
authority, or those for hom he7she is functioning, from any liability by virtue of any
blurring, distortion, alteration, o$tical illusion, fictitious names, fictitious story lines, or use
in com$osite form hether intentional or otherise, that may occur or be $roduced in the
taking of said $icture, video or in any subse6uent $rocessing thereof, as ell as any
$ublication thereof, including ithout limitation any claims for libel or invasion of $rivacy.
Model also confirms that she7he has the right to enter into this Agreement, that she7he is
not restricted by any commitments to any $arties, and that /LP 0en. Part. has no
financial commitment or obligations to me as a result of this Agreement besides the
consideration already $aid.
I hereby give all clearances, co$yright and otherise, for use of my name likeness, image
voice, a$$earance and $erformance embodied in the Product. I e1$ressly release and
indemnify /LP 0en. Part. and its officers, em$loyees, agents and designees from any
and all claims knon and unknon arising out of or in any ay connected ith the above
granted uses and re$resentations. 4he rights granted /LP 0en. Part. herein are
$er$etual and orldide survive my death and any other occurrence.
In consideration of all the above, I hereby acknoledge recei$t of reasonable and fair
consideration from the Photogra$her named belo, received and $aid.


AS TO MODEL:
M+"8L&
&I0NA4938:

"ated on:
I the above%signed model do hereby certify and sear under declaration of $er5ury that the
folloing is true and correct by my above signature and that I agree ith such terms.
I sear that I am above :; years of age
I sear that I have disclosed my correct legal name
I sear that I have disclosed all other names that I have been knon by
I sear that I have $roduced legal identification cards
I sear that I have not $rovided any false or misleading information to $roducer or
$hotogra$her

AS TO P(OTO)RAP(ER * STUDIO:
Photogra$her Name:
)om$any Name:

Address:
"ate of Photo &hoot::

AS TO +ITNESSES:
I the undersigned itness do hereby sear under declaration of $er5ury that I itnessed
the above model sign this documents and sear to the above statement.
'I4N8&&
&I0NA4938

Printed Name
Address
)ity, &tate, )ountry