Model Realease Form
Photographic/Interview/Video Consent & Release Form
______________________
Bernardo Arriola, Producer Date :_____________
Vegas Pinoy TV Program
3420 S.Jones Blvd, Ste 1 Location:___________
Las Vegas, NV 89146
Jhune0316@yahoo.com Description: _________
For valuable consideration, I hereby give you, Bernardo Arriola permission to use my photographs/videos/interviews and I authorize the use and reproduction of it by you
or anyone authorized by you . This includes any and all photographs/interviews/videos
which you have this day taken of me, for any purpose whatsoever without further
compensation to me. All negatives/positives, prints and electronic copies shall be your
sole property.
I am over 18 years of age . Yes ________ No_______
Model/Subject/Interviewee: _____________________________________
Address and Telephone Number / e-mail: ____________________________
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