USA Adult Directory Model Release

MODEL IDENTIFYING INFORMATION AND AFFIDAVIT: Model understands that all the information given in this Agreement is being provided to comply with federal law and any false statement will subject Model to both a civil action by Producer as well as criminal prosecution under federal and state law.  _____________

                                                                               (Model’s Initials)

Please print legibly.

a.         Legal Name: _________________________              b.         Date of Birth: ____________

                                 (Full Current Legal Name: First, Middle, Last)                                                                             

(Month, Day and Year)

                                                                                                            Age: ___________ ___ ___________________

c.         The aforementioned information was acquired by the mandatory examination of the following Two Forms of Identification, including at least one government-issued photo identification document such as a Valid Driver’s License or a Passport:  (Each should be described, including the ID number. Clear, good-quality photocopies of each must be attached to this Form and the photocopies must be signed in ink by Model):

            (1) First form of identification:               (2) Second form of identification:

            ____________________________                ___________________________________

            ID # ________________________                ID # _______________________________

Note:  If ID does not contain a recent and recognizable picture of the Model, only a Drivers’ License, State ID Card or Military ID will be acceptable for U.S. Models; and only a passport will be acceptable for foreign Models, in such circumstances.  Unless both the Model and the producer are located outside the U.S., a ‘picture identification card’ as defined in CFR 75.2(a)(1) must be examined to ascertain the model’s legal name and date of birth prior to completing this form.

d.         All other names ever used (include all stage names, Web handles, maiden names, aliases, professional names and nicknames):

            (1) ____________________________           (a) _________________________________

                         (Stage Name for this Production)                                           (All other names)

            (2) ____________________________           (b) _________________________________

                         (Maiden Name if applicable)                                                   (All other names)

            (3) ____________________________           (c) _________________________________

                         (Previous legal name, if applicable)                                        (All other names)

Sworn statement: “under 28 U.S.C. §1746 and the penalties of perjury under the laws of the united states, I swear that the foregoing is true and correct and that each of the identification documents which I have provided and of which I have signed the attached copy was lawfully obtained by me and has not been forged or altered.”

If photos are being provided by the model, model has rights to or owns provided photos and that they were taken after model’s 18th birthday.

Today’s Date:_________________

Signature:      _______________________________________           

                      Model’s Signature (using full legal name)

Date of Photo Session:____________________

MODEL MUST ALSO SIGN AND DATE THE ID COPIES!

Model does NOT sign the following:

Under 28 U.S.C. §1746 and the penalty of perjury under the laws of the united states, I swear that the foregoing is true and correct, that I have personally examined the model’s photo identification and date of birth, that I have personally questioned the model regarding the answers given in this agreement, and that I have observed the originals of each of the identification documents of which copies are attached hereto and signed by the model.   In addition, I swear that the date set forth below is the date on which production occurred if USA Adult Directory was primary producer.

Today’s Date:   _________________

_____________________________             

Print Name of  USA Adult Directory representative and/or Primary Producer

_____________________________

Signature of USA Adult Directory and/or Primary Producer  representative