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Print
this page out, fill in your information and fax
it to: (818) 865-0040.
In
exchange for consideration received, I hereby
give permission to Operation Interdependence® to use my name and photographic
likeness in all forms and media for advertising,
trade, and any other lawful purposes.
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Print
Name:
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____________________________
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Phone number with area code:
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_________________
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Street address:
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____________________________
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City, St, Zip code:
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____________________________
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Signature:
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____________________________
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Date:
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_________________
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If Model is under 18: I, ________________________,
am the parent/legal guardian of the individual
named above, I have read this release and approve
of its terms.
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Print
Name:
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____________________________
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Signature:
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____________________________
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Date:
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_________________
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