Model Release Form

In order to have your picture appear on the Shades Of Black Magazine website you must fill out the following model release form. Send the completed form along with photocopies of 2 forms of ID. One must be a photo ID (such as driver’s license, passport, work or school ID card). The second form of ID can be a birth certificate, Social Security card, marriage certificate or immigration card.

If your photos are already scanned, simply email them to us at Shadesofblackmag@hotmail.com

If you have prints that require scanning please include them with your completed model release form and mail them to:

SHADES OF BLACK PUBLICATIONS, c/o Shades Of Black, Magazine POB 18153 Milwaukee WI. 53218 90405

Models Real Name ___________________________________________________________________

Models Alias Name (for use on site) _____________________________________________________

Date of Birth ________________________________________________________________________

Address ____________________________________________________________________________

City, State/Province, and Zip/Postal code _________________________________________________

Email Address: ______________________________________________________________________

Do you want your email attached to your picture so that people can email you? Yes or No _____

Do you wish to have your prints returned to you? Yes or No _____

I hereby certify that these are my own personal pictures and are not pictures copyrighted by anyone else. I give SHADES OF BLACK PUBLICATIONS (shadesofblackmagazine.com) permission to publish these photographs of myself on the Shades Of Black’s website and to make adjustments to such photographs as shall deem proper to their use. I certify that I am of full age (18) and am possessed of full legal capacity to execute the foregoing authorization. I further agree that if I am selected, that for said consideration, this will serve along with the Model Release Form as permission to publish photos on the Shades Of Black Magazine.com website.

Model's Legal Signature _____________________________________________________________

WARNING: Anyone signing this release form other than the model will be subject to monetary damages and/or criminal prosecution.