MODEL RELEASE FORM
For good and valuable Consideration herein acknowledged as received, and by
signing this release I hereby give the Photographer and Indiana’s Historic
Pathways my permission to license the Images and to use the Images in any Media
for any purpose (except pornographic or defamatory) which may include, among
others, advertising, promotion, marketing and packaging. I agree that the Images
may be combined with other images, text and graphics, and cropped, altered or
modified. I agree that I have no rights to the Images, and all rights to the
Images belong to the Photographer and Indiana’s Historic Pathways. I acknowledge
and agree that I that images are being submitted in a photo contest and that I
have no right to any prizes, awards, or compensation presented to the
Photographer. I have no right to additional Consideration or accounting, and
that I will make no further claim for any reason to Photographer or Indiana’s
Historic Pathways. I acknowledge and agree that this release is binding upon my
heirs and assigns. I agree that this release is irrevocable. I represent and
warrant that I am at least 18 years of age and have the full legal capacity to
execute this release or I represent and warrant that I am the legal guardian for
this minor (17 years old or younger) and have the legal capacity to execute this
release.
Indiana’s Historic Pathways is a non-for-profit organization. We will not sell
or distribute these photos for any other purposes other than self marketing the
byway.
Model Information
Name (print) ______________________________________________________
Address _________________________________________________________
City __________________________________ State _____Zip Code _________
Phone _______________________ Email ______________________________
Date of Birth ___________________
Signature _______________________________________________________
Date _________________________
Or for a minor (17 years old or younger)
Name of guardian (print) ____________________________________________
Signature ________________________________________________________
Photographer Information
Photographer Name (print) __________________________________________
Photographer Signature_____________________________________________
Date of Photograph____________________
Return completed form to:
Indiana's Historic Pathways
c/o Historic Southern Indiana
8600 University Blvd
Evansville IN 47712
or by fax: 812/465-7061