Remote Model Release Form

            I, ___________________________________, do hereby give Alekz D. Londos, from PSYCHOSiiS, including clients, licensees, purchasers, agencies, and periodicals, the irrevocable right to use my nude or/and clothed photographs and/or digital video for reproduction in any medium including but not limited to print and electronic, Internet for purposes of advertising, trade, sold, display, exhibition, editorial or promotional use.  I declare that the photographer who took the photos and I, of the model, have an understanding where by, I have the rights to give full permission to Alekz D. Londos to use the images I supplied, both printed images, electronic files (formatted images) and digital video, edited DVC, DVD, VHS, T.V. broadcast, or web-cast.  I also declare that the person in the photographs and/or digital video is indeed me.

            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 or video that the photographer has taken of me or the use to which it may be applied.  Knowing it will be used in my best interest, I further release Alekz 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 the Model to conspicuous ridicule, scandal, reproach, and indignity.  I acknowledge that the photography session was conducted in a completely proper and professional manner, and this release was willingly signed.   I affirm that I am more than 18 years of age.   I have read this release and fully understand its contents. 

            I understand that I should include a copy of my Driver's License or some form of signed, picture ID with my birth date on it.  I will turn over all rights for my stage name if different from signed name, will play in cast list in any production I am in [possibly on the web site www.PSYCHOSiiS.com] or future movie.

Stage Name: __________________________________________ 

Signed:____________________________________Telephone:___________________________

Print Model's Legal Name:________________________________________________

I.D. number: _______________________________________

Address: ______________________________________

City: _________________________ State: _______ ZIP: ____________

E-Mail Address: ____________________________________________________

Date: ______________ Witness: ______________________________________

Please fill out this form and include with copy of ID when if you submit your pictures and/or video to me...Model Dept, E-Mail modeling@psychosiis.com

If there is anything you in question, in the release form, it can easily be altered or removed for you (the form generally covers most categories)