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.





April 22, 2024

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Signed by Andrei Severny
Signed On: September 4, 2023


Signature Certificate
Document name: RELEASE FORM
lock iconUnique Document ID: 41ea292685f5259c74ce80878af387ec887d62e2
Timestamp Audit
February 6, 2018 3:37 pm EDTRELEASE FORM Uploaded by Andrei Severny - info@nyheadshots.com IP 100.12.241.245
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