Model Release Form printable pdf download

Model Release Form

MODEL RELEASE FORM

This form gives your permission to ShortList Media to publish and/or place the

interview/case study you have supplied.

I hereby acknowledge and agree:

1. ShortList Media and any of its customers, affiliates or agencies are entitled to make

whatever use of the interview/case study and all reproductions thereof, either wholly or

in part, in any manner or form whatsoever and in any medium or format and either

separately or in conjunction with other case studies and interviews.

2. That I waive all moral rights or any similar personal rights.

3. That unless my name is published, used or referred to in connection with the publication

of the case study/interview, neither the article nor reproductions thereof nor any

statement nor words published or reproduced in conjunction with or in relation

thereto shall be deemed to be attributed to me personally.

SUBJECT SIGNATURE _________________________I am over 18 years old

PRINT NAME _______________________________ D.O.B ____________

ADDRESS ____________________________________________________

___________________________________________ MOB _____________

Model Release Form