Name *

First Name

Last Name

Model Release Form

I grant ALTVRA Company/Pleasant Prairie the right and permission concerning any photographs or video taken of me or in which I may be included with others, to use, and publish in any and all media now or hereafter known and for needed purposes, and to use my name in connection as needed. I release and discharge Photographer and Videographer from any and all claims and demands that may arise out of or in connection with the use of the photographs and video. I am a legally competent adult and have the right to contract in my own name. I have read this document and fully understand its contents.

I Accept