Image Release Form

          I, _____________________________________ do hereby give Alekz D. Londos, from PSYCHOSiiS, including clients, licensees, purchasers, agencies, and periodicals, the irrevocable right to use my provided images, pictures, digital photo’s, slides, negatives, 35mm, memory stick, CD, Music, Zip, Disk, DAT, DVD, Mini DV, DVC, Hi8, 8mm, Digital 8, VHS, S-VHS, VHS-C, Avi, or MP3 transferred, via source, for multiple uses, as fallows

            On the web site PSYCHOSiiS.com, in the next video production following PSYCHOSiiS, similar to PSYCHOSiiS different in style.  Contact information if accepted, can be used.  I can possibly request, and acquire free copies of the production.  Any additional ideas can be talk over, to continue to move forward.

I hereby waive any right that I may have to inspect and approve the finished product or copy edited video that may be used in connection with an image that I have provided which it may be applied.  Knowing it will be used in my best interest, for reproduction in any medium including but not limited to print, both printed images, electronic files (formatted images) electronic Internet, and digital video, edited DVC, DVD, VHS, T.V. broadcast, or web-cast.  For purposes of advertising, trade, sold, display, exhibition, editorial or promotional use.  I declare I was photographer who took the photos/video, of the consenting actors/people/model, have an understanding where by, I have the rights to give full permission to Alex D. Londos from PSYCHOSiiS to use the images I supplied,

I further release Alex D. Londos for whom he is/are acting, from any claims for remuneration associated with any form of damage, foreseen or unforeseen, associated with the proper commercial or artistic use of these images…unless it can be shown that said reproduction was maliciously caused, produced and published for the sole purpose of subjecting negative, conspicuous ridicule, scandal, reproach, and indignity.  I acknowledge that all photography session were conducted in a completely proper and professional manner, and this release was willingly signed.  I affirm that models if any, are more than 18 years of age.  I have read this release, and fully understand its contents. 

            I will turn over all rights for my photographers or [digital] video photographers name if different from signed name, will play in cast list in any production my source will be located in, after PSYCHOSiiS, possibly on the web site www.PSYCHOSiiS.com in the photographer list, or future magazine.

Photographer or [digital] Cinema photographer____________________________________________          

Signed:______________________________Print your name:_____________________________

I.D. number: ________________________ E-Mail Address: ______________________________

Address: _______________________________Telephone:___________________________

City: _________________________ State: _______ ZIP: __________ Date: _________________

Witness________________________________ Telephone:___________________________

Please fill out this form, submit your pictures and/or video to me.  E-Mail PSYCHOSiiS@Hotmail.com any one in the cast, list them on back, fill in the contact information.  And have them fill out  the Model Release Form.