NY Headshots

RELEASE FORM


Assignment: Photo/video session

City:

I, being of legal age, hereby consent, that my image and likeness as shown in the photographs, videos, and/or electronic images in which I appear, and/or audio recordings made of my voice may be used by iRolls Multimedia LLC and the team of NYheadshots.com, its assigns or successors, in any form they choose, including but not limited to internet, social media, software, pamphlets, newspapers, magazines, brochures, reports.

By signing below I acknowledge I have read, understand and agree with the release.



May 23, 2019

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Signed by Andrei Severny
Signed On: January 30, 2019

Signature Certificate
Document name: RELEASE FORM
Unique Document ID: b4be7de2e874d5932acedd0b37a17921953776fd
Timestamp Audit
February 6, 2018 3:37 pm EDTRELEASE FORM Uploaded by Andrei Severny - a@irolls.com IP 98.13.255.136
July 23, 2018 2:54 pm EDTNY Headshots - info@nyheadshots.com added by Andrei Severny - a@irolls.com as a CC'd Recipient Ip: 98.7.213.123
November 10, 2018 11:26 pm EDTNY Headshots - info@nyheadshots.com added by Andrei Severny - a@irolls.com as a CC'd Recipient Ip: 104.162.238.42
November 10, 2018 11:28 pm EDTNY Headshots - info@nyheadshots.com added by Andrei Severny - a@irolls.com as a CC'd Recipient Ip: 104.162.238.42
November 10, 2018 11:32 pm EDTNY Headshots - info@nyheadshots.com added by Andrei Severny - a@irolls.com as a CC'd Recipient Ip: 104.162.238.42
January 30, 2019 12:29 pm EDTNY Headshots - info@nyheadshots.com added by Andrei Severny - a@irolls.com as a CC'd Recipient Ip: 98.13.255.136
January 30, 2019 12:40 pm EDTNY Headshots - info@nyheadshots.com added by Andrei Severny - a@irolls.com as a CC'd Recipient Ip: 98.13.255.136
January 30, 2019 12:51 pm EDTNY Headshots - info@nyheadshots.com added by Andrei Severny - a@irolls.com as a CC'd Recipient Ip: 98.13.255.136
January 30, 2019 1:00 pm EDTNY Headshots - info@nyheadshots.com added by Andrei Severny - a@irolls.com as a CC'd Recipient Ip: 98.13.255.136
January 30, 2019 1:09 pm EDTNY Headshots - info@nyheadshots.com added by Andrei Severny - a@irolls.com as a CC'd Recipient Ip: 98.13.255.136
January 30, 2019 1:11 pm EDTNY Headshots - info@nyheadshots.com added by Andrei Severny - a@irolls.com as a CC'd Recipient Ip: 98.13.255.136
January 30, 2019 1:13 pm EDTNY Headshots - info@nyheadshots.com added by Andrei Severny - a@irolls.com as a CC'd Recipient Ip: 98.13.255.136
January 30, 2019 1:17 pm EDTNY Headshots - info@nyheadshots.com added by Andrei Severny - a@irolls.com as a CC'd Recipient Ip: 98.13.255.136
January 30, 2019 1:19 pm EDTNY Headshots - info@nyheadshots.com added by Andrei Severny - a@irolls.com as a CC'd Recipient Ip: 98.13.255.136