HowieSpace Photography Photo Release

HowieSpace Photography Photo Release v.1.1

Please read acknowledge and complete this entire form. Please call me with any questions at 407.406.3915 or text me. I will get back to you as soon as possible.

First Name: *
Last Name: *
Requested Photo Gallery Title:
Modeling Name:
Street Address 1: *
Street Address 2:
City: *
State: *
Zip Code: *
Mobile Phone: *	i.e. 407.406.3915
Other Phone:
Your Email: *
Model Mayhem URL:
Facebook URL: *	I want to see the "Real" you!
Twitter URL:
MySpace URL:
ACKNOWLEDGEMENT	I hereby grant Howie Huynh, HowieSpace Photography, its representatives, and employees (from here forth known as HowieSpace) the right to take photographs of me and my property. I authorize HowieSpace, its assigns and transferees to copyright, use and publish the same in print or electronically. I agree that HowieSpace may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content.
	I have read and completely undestnad the above disclaimer and release.
Special Request(s)
New Password: *	To your photo gallery
Repeat Password: *	Are you sure?
Security Code: *