TravelReporter.com     
Submission Form & Model Release     
(Please print out)    
(A signed, completed copy of this form must be mailed to the publisher upon each submission.  Please include this form with mailed submissions or mail this form separately if work is submitted electronically.)

Contributor Information

Name:

Mailing address:
 
 

Telephone number w/ area code: (           ) 

Email address:

Social Security Number (IRS Requirement):

Title of work submitted with this form:

Brief description of submission (continue on back):
 
 

Model release enclosed (circle):   Yes     No 

Statement of ownership and responsibilities:  "In signing this submission form, I certify that the work I have submitted is my own creation and that I have full and total rights to this material.  I have either included signed model releases or have determined that no model releases are needed and take full responsibility for this determination.  I have read and agree to all of the provisions of the TravelReporter Submission Guidelines and accept all liability from claims that may arise from my written, recorded or photographic work.  I grant TravelReporter.com the right to offer and display the above-defined work as outlined in their published guidelines and accept as payment in full cash or merchandise, as explained in this guide.  The sole remedy for any dispute that should arise from this submission is the timely withdrawal from publication of the work in question.  The compensation, if any, accepted in return for publishing rights of this work represents my sole claim in any future dispute.  I am a freelance contractor and accept full responsibility for all taxes payable as a result of this submission."

Read and signed on ______________ (date)

By:                                                                        (contributor)

 (Mail the signed form to: Publisher, TravelReporter.com, 30935 Branford Drive, Temecula, CA 92591  Email questions to questions@travelreporter.com.)

 


 
 
Standard Model Release Form

I,                                                              do hereby give                                                        ,
his/her assigns, licenses, and legal representatives the irrevocable right to use my name (or any fictional name), picture, portrait, or photograph in all forms and media and in all manners, including composite or distorted representations, for advertising, trade, or any other lawful purpose, and I waive any right to inspect of approve the finished product, including written copy, that may be created in connection therewith, in consideration of $ (no compensation) , receipt of which is acknowledged.  I am of full age.*  I have read this release form and an fully familiar with its contents.
 
Witness:   Signed: 
Address:   Address: 

Date:                   20      
* Delete this sentence if the subject is a minor.  The parent or guardian must then sign the consent below.

Consent (If applicable)

I am the parent and/or legal guardian of the minor named above and have the legal authority to execute the above release.  I approve the foregoing and waive any rights in the premises.
 

Witness:   Signed: 
Address:             Address: 
Date:                   20