Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Type of Session *

Portraits

Engagement

Maternity

Wedding

Other (please describe in Other Wishes)

Prefered Dates *

MM

DD

YYYY

Model Release

I hereby authorize Keeli Howard to publish photographs taken of me, and my name and likeness, for use in Keeli Howard's print, online and video-based marketing materials, as well as other publications. I hereby release and hold harmless Keeli Howard from any reasonable expectation of privacy or confidentiality associated with the images specified above. I further acknowledge that my participation is voluntary and that I will not receive financial compensation of any type associated with the taking or publication of these photographs or participation in Keeli Howard's marketing materials or other publications. I acknowledge and agree that publication of said photos confers no rights of ownership or royalties whatsoever. I hereby release Keeli Howard, her contractors, her employees, and any third parties involved in the creation or publication of marketing materials, from liability for any claims by me or any third party in connection with my participation.

I hereby agree to and understand the conditions of the completed model photo release. I grant Keeli Howard the unrestricted right to use and publish photographs for editorial, trade, advertising, and other purposes.