Model Release & Questionnaire Model Release & Questionnaire NameFirstLastAddressStreet AddressAddress Line 2CityState / Province / RegionZip / Postal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweCountryPhoneEmailReferred byComments or suggestions: Please use this space if you'd like me to do anything specific for your session (pose, props, etc). If there is a particular pose that you absolutely love or one that you don't care for, please list it here. COPYRIGHT OWNERSHIP: LuxeMod Photography (the “Photographer”) owns all right and title to the copyrights in all images and photographic materials created on behalf of the Client and shall have the exclusive right to make prints or reproductions. The Photographer reserves and the Client expressly grants the express right of Photographer to make reproductions and use the photographs and images of Client and/or Client's minor children listed above for use in connection with the Photographer's portfolio, samples, self-promotions, entry in photographic contests or art exhibitions, advertising and promotion, books, magazines, illustrations, editorial use, or for display within or on the outside of the Photographer's studio, on Photographer's website, including on all printed materials, media on the Internet, and any current or future digital media. Photographer reserves the right to sell and distribute such materials upon written notice to Client at the address listed above. Nothing herein shall be deemed as a release, transfer, assignment or other disposal of Photographer’s rights in the materials. CLIENT'S RIGHTS TO USE MATERIALS: Client agrees that all images shall be printed through LuxeMod Photography or its authorized representative. Client shall not print, copy, or otherwise reproduce any of the images without the express written consent of LuxeMod Photography. Client is obtaining prints for personal use only and Client shall not sell said prints or authorize any reproductions of the prints by any third party unless such reproduction is authorized in writing by the Photographer. If Client purchases limited, non-exclusive usage rights to digital files, such usage shall be for personal, non-commercial use only. *I AGREE no comments link to this post email a friend Your email is never published or shared. Required fields are marked * Name * Email * Website There was an error submitting your comment. Please try again. Comment
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