Photographer Information

Name: _________________________________________________________________

Check Payable to: _____________________________________________________

PayPal Email (optional): ______________________________________________

Social Security Number: _______________________________________________

Mailing Address: ______________________________________________________

City: _________________________________________________________________

State: ________________________________________________________________

Zip Code: _____________________________________________________________

Country: ______________________________________________________________

Email Address (PRINT CLEARLY!): _______________________________________

Phone: ________________________________________________________________

I certify that I am the owner of the photos being submitted and that by
accepting payment as "work for hire" I am releasing all ownership and 
interest in them. I also certify that all models were 18 years of age or
older when photographed.

Signature: _________________________________ Date: ____________________