Full Name:_____________________________________
ADDRESS: _____________________________________
CITY: _____________ STATE_____ ZIP CODE: ________
EMail Address ; __________________________________
I prefer [1] one of these [3] three shirts as the one I would like to model in if they are available.
1:____________________________
2:____________________________
3:____________________________
SHIRT SIZE: S:_____ M:_____ L:_____ XL:_____ 2XL:_____ 3XL:_____ 4XL:____
By signing below, you acknowledge that you are at least 18 years of age, and that your image may be used in at least one(1) web-based and/or physical catalog as well as at least one(1) print-based and/or web-based calendar layout as well. You further acknowledge that you will receive one(1) T-Shirt and one(1) copy of the calendar as well in lieu of monetary reimbursement. You agree to indemnify and hold blameless and harmless the proprietor(s), any and all authorized agents thereof, and affiliates, contractors, sub-contractors in the event of any misuse or misappropriation of your image. You further acknowledge your responsibility to review any and all applicable laws of your country, state, county, and/or any other recognized civil, legal, or military authority that may make this or any other similar transaction illegal or unauthorized.
You agree to waive any and all liability for the use of your image, and this or any offer written or implied is void where prohibited by law.
Signature:________________________________ Date:______________ |