Photograph and/or Video Release Form

I __________________________ grant permission to use my Photograph or Video of

____________________________in any official publicity pieces. Publicity
pieces include (but are not limited to) news releases, publications, videos
and web use.

To:

Name: _______________________________________________________

Address:___________________________________________________

City: ___________________________ State: _____________ Zip: _________

Phone:____________________________

Model's Signature: __________________________________ Date: _________

Witness: __________________________________________ Date: _______

Please print and fill out this form,  then return it to Events To Go Inc.
office for signature of photographer.

Events To Go Entertainment
105 Buchanan Ave
Cape Canaveral, FL 32920
321.868.6800 / 321.868.6977 fax