Orange County Business Owners $100 Individual Headshot Session

Name *

First Name

Last Name

Phone

(###)

###

####

What date works best for you? *

MM

DD

YYYY

Where will the shoot take place?

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I, for good and valuable consideration, the receipt of which is hereby acknowledged, hereby irrevocably authorize Daniel Rainey to use photographs of me and or my property and authorize him and his assignees, licensees, legal representatives and transferees to use and publish (with or without my name, company name, or with a fictitious name) photographs, pictures, portraits or images herein described in any and all forms and media and in all manners including composite images or distorted representations, and the purposes of publicity, illustration, commercial art, advertising, publishing (including publishing in electronic form on CDs or internet websites), for any product or services, or other lawful uses as may be determined by the photographer or studio name here. I further waive any and all rights to review or approve any uses of the images, any written copy or finished product. I am of full legal age and have read and fully understand the terms of this release.