Model Release  (Compensated Adult)

b   e   u s s e r y™   imagery co.
www.beussery.com   


In consideration of _____________________ Dollars ($____________), receipt of which is acknowledged, I, ______________________________, do hereby give Brian E. Ussery, his assigns, licensees, and legal representatives the irrevocable right to use my name (or any fictional name), picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for advertising, trade, or any other lawful purposes, and I waive any right to inspect or approve the finished version(s), including written copy that may be created in connection therewith. I am of full age. I have read this release and am fully familiar with its contents.

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Witness___________________________________

Social Security Number_______-____-_______

Address___________________________________



Model_____________________________________

Social Security Number_______-____-_______

Address___________________________________

Date ___________, 2003