Photography Release

I, hereby grant permission to Young Again Cosmetic Injections to reproduce any portion of the photo images that have been taken by me, Diane Chuprun, RN, LLC. for the purpose of SELF USE and or SELF PROMOTION publications which can include but is not limited to, books, cards, calendars, invitations and websites without any more compensation or recognition given to me.

Furthermore, I grant creative permission to alter the photograph(s). I do NOT grant permission to resale or use the photographs in a manner that would exploit or cause malicious representation toward me or my company and associates.

Permission granted for photographs taken on or after the signed date below. Any retraction of permission must be given in writing and a good faith effort to remove all pictures will be made as soon as possible.

Any infringements of this policy may violate federal law.

Name

First Name

Last Name

Date

MM

DD

YYYY

Signature

Please consider this my legally binding signature

I understand the terms of the photography release

I understand

BACK TO FORMS