Photo Release Form

I hereby give (Writer), writer's publisher, successors and assigns permission to copyright and/or publish any photograph(s) of myself with or without using my name and to keep changes and/or additions to such photographs, portraits in such manner as shall seem proper to their use. I also understand that editorial matter will at times accompany these photos. I certify that I am of full age 18 and am possessed of full legal capacity to execute the foregoing authorization.

By filling out the form and signing below, I agree to the terms stated above.

Name:________________________________

Birth Date:__________

Street address:_________________________________

City:__________________State:______________Zip:_______________


Please mail this form and picture to:

He Looks Like
2180 Westwood Blvd., Suite 1-J
PMB #237
Los Angeles, CA 90025

If picture is digital, please email a high resolution file to: brokenhalo6@gmail.com