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New Jersey Model Release Form

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This form is provided by Programmer

New Jersey Model Release Form
New Jersey Model Release Form
Programmer’s Paradise Inc.
1157 Shrewsbury Avenue, Shrewsbury, NJ 07702
Model Release Form
This form must be completed by any recognizable
individuals in any photo submitted to our photo contest.
I, ____________________________, hereby grant Programmer’s Paradise an irrevocable license to use my
likeness now or at any time in the future, throughout the world in any manner it so chooses and in any medium
now known or later developed. This includes, without limitation, use on Programmer’s Paradise magazine
advertisements, corporate brochures and any other promotional material it wishes. I acknowledge that
Programmer’s Paradise is under no obligation to use my likeness.
I agree that there are to be no fees, commissions or royalties paid to me for the use of my likeness. I acknowledge
and agree that I have the exclusive right and authority to grant this license to use my likeness.
Please PRINT the following information and fax to 732.460.9317. Be sure to include your signature at the bottom.
Contestant:
___________________________________________________________________________________________________
First Name Last Name
Home Address: ___________________________________________________________________________________________________
Street or P.O. Box
___________________________________________________________________________________________________
City State Zip
E-Mail Address: _______________________________________________________________________________
Telephone: _______________________________________________________________________________
Photographers Name: ___________________________________________________________________________________________________
Description of Photo: ___________________________________________________________________________________________________
(Please use the same description you used for your photo on the website upload form)
Signature of Contestant: _______________________________________________________________________________
Date
Parent/Guardian: _______________________________________________________________________________
(If a minor) Date
New Jersey Model Release Form