Model Release for The Big Picture

The Big Picture
P.O. Box 511
Maricopa, CA. 93252

I, ___________________________________ grant permission to The Big Picture to use my picture(s) on their web site. I can revoke this permission at any time by notifying The Big Picture in writing at the above address or by fax at:(661) 769-8238

I affirm that I am at least 18 years of age.

Name: ______________________________________

Date of Birth: ______________

Address: ____________________________________ City: ___________________ St: _____

Telephone Number: (______)_____________________________

Zip: _______________

Email: __________________________

Model Signature: _____________________________________________

Date: ______________