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DebtTriage.com Model Release Form

 
Date:
  ____________________
     

For consideration received including the opportunity to gain exposure, the receipt and adequacy of which are hereby acknowledged, I irrevocably grant to DebtTriage.com, ("Company") and Company's assigns, affiliates, licensees and successors the right to use my name, voice, likeness and performance, which can include audio, video or both, and any original material(s) created by me which is(are) incorporated into the media (e.g., artwork, dialogue, musical composition(s), literary material, etc.), in all forms and media including composite or modified representations (“Media”) for all purposes including any commercial purpose such as advertising throughout the universe and in perpetuity. I waive the right to inspect or approve versions of my image or voice used for publication or the written copy that may be used in connection with the material. I release Company and Company's assigns, affiliates, licensees and successors from any claims that may arise regarding the use of materials including any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity or copyright.

 

I represent and warrant that (1) I have read and understood this agreement, (2) I am over the age of 18, (3) I am an individual appearing in Media and have the full right and authority to enter into this agreement and to grant the rights herein, (4) I am not a member of any writing, theatrical, motion picture or television union or guild. I hereby agree to indemnify and defend Company against any and all losses, claims, debts, demands, liabilities, attorneys’ fee and all other damages or costs related to the above.

 

This Agreement expresses the complete understanding of the parties.

 

ALL MATERIALS ENTERED ARE NOT RETURNABLE and become the property of DebtTriage.com.

 
Name:
  ___________________________________________
     
Address:
 

___________________________________________

___________________________________________

___________________________________________

     
Phone Number:
  ___________________________________________
     
E-Mail Address:
  ___________________________________________
     
Signature:  ___________________________________________
 
Parent/Guardian Consent [include if the named person above is under the age of 18]
 
I am the parent or guardian of the minor named above. I have the legal right to consent to and do consent to the terms and conditions of this Model Release.
 
Name:
  ___________________________________________
     
Address:
 

___________________________________________

___________________________________________

___________________________________________

     
Phone Number:
  ___________________________________________
     
E-Mail Address:
  ___________________________________________
 
Signature:  ___________________________________________
 
Witness
 
Witness Signature:  ___________________________________________
 
Please send the completed form to:

DebtTriage.com
14150 NE 20th St., Suite F1
Bellevue, WA 98007