ADULT MODEL RELEASE: 2257 COMPLIANT FORM
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2257 Compliant Section:
*Full Legal Name of Performer:
*Stage Name:
*Maiden Name:
*Previous Legal Name:
 Previous names:
*Address:
*City:
*State:
*Zip Code:
*Date of Birth:
*Age:
*Phone:
*Email Address:
*I wish to apply for: |  Cams  |  Phones  |  Cams and Phones  |
   
If you choose phones, will you rent photographs from Midnite Secrets?  
( $10 per paycheck )  Yes No

The Representative has been shown the following items as proof of the age of the performer, copies of which have been left with the representatives and are photographed or copied:

IDENTIFICATION:

*Driver License/ID Number:
*Social Security Number:
 or
*US Passport Number:
 or
*Foreign ID Number:

Model understands that all information given in this agreement is to comply with FEDERAL LAW and any false statement will subject PERFORMER to both a civil action by Global Assets, LLC. as well as criminal prosecution under both FEDERAL and STATE LAW. 

*Performer Initials:

SWORN STATEMENT: UNDER 28 U.S.C. 1746 AND THE PENALTIES OF PERJURY UNDER THE LAWS OF THE UNITED STATES, I SWEAR THAT THE AFOREMENTIONED 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.

*Performer Signature (Full Name):
*Print Name:
*Date:

Performer/Model Release Section:

I, the undersigned performer/model, (hereafter PERFORMER), do hereby voluntarily authorize and give permission to Global Assets, LLC and it’s affiliates, Midnite Secrets, Midnite Socials, or Enighttalkand their assigned (hereafter REPRESENTATIVES) to the full and free use of: photographs, vocal recordings, video, electronic and digital reproductions in any form of my person or personal property. From the date of execution of this General Release of Authorization, the PERFORMER does hereby grant, release and assign to REPRESENTATIVES any or all claims of right whatsoever in and to all photo or printed materials of the PERFORMER or by the PERFORMER and delivered to REPRESENTATIVES for any purpose chosen by REPRESENTATIVES. I give the REPRESENTATIVES the absolute right and permission to copyright, use, reuse, publish, exhibit display, print and reprint in advertising publicity or promotional material, magazines, books or any other media, or for any other purposes, the Photograph and video heretofore taken or presented, or hereafter taken or presented to the representatives and for which I have acted as a model, including without limitation, reproductions thereof of which I may be included in whole or in part. From execution hereto and for value received and acknowledged below by PERFORMER, REPRESENTATIVES shall exclusively and irrevocably own in perpetuity all right, title and interest, including copyright, in and to the digitized photographs, reproductions, video, vocal recordings and any digitized printed material (hereafter PRODUCT) of the PERFORMER with no rights expressly reserved by the PERFORMER.

PERFORMER also grants REPRESENTATIVES and it’s designees the right to use his/her name, likeness, image voice, appearance, and performance as embodied in the PRODUCT whether recorded on or transferred to video tape, film, slides, photographs, audio tapes, or other media, now known or later developed.

This grant includes, without limitation, the right to edit, mix or duplicate and to use or re-use the PRODUCT in whole or part as the REPRESENTATIVES may elect. REPRESENTATIVES or it’s designee shall have complete ownership of the PRODUCT in which the PERFORMER appears, including copyright interests, and the PERFORMER acknowledges that he/she has no interest or ownership in the PRODUCT or it’s copyright. PERFORMER also confirms that he/she is not restricted by any commitments to any other parties, and that the REPRESENTATIVES has no financial commitments or obligations to me as a result of this agreement, besides the consideration provided.

PERFORMER hereby gives all clearances, copyright and otherwise, for use of my name (OR STAGE NAME), likeness, image voice, appearance and performance embodied in the PRODUCT. I expressly release and indemnify REPRESENTATIVES and it’s officers, employees, agents, and designees from any and all claims known and unknown arising out of or in any way connected with the above granted uses and representations. The rights granted REPRESENTATIVES herein are perpetual and worldwide, survive my death and any other occurrence.

The PERFORMER hereby waives any right to inspect or to approve the Photographs/Videos or the editorial or advertising copy or printed matter that may be used by the Users in conjunction therewith, and further waive any claim that I may have with respect to the eventual use to which it may be applied. Such Photographs/Video may be used in the sole discretion of the Users, with or without my name or with a fictitious name, and with fictitious or accurate biographical material, alone or in conjunction with any other material of any kind or nature. I hereby release, discharge and agree to save harmless the Users and their licensees and assigns from and against any and all liability connection with the use of such Photographs/Videos. Without limiting the foregoing, the Photographs/Videos may be used in magazines and internet websites/DVDs etc., which contain sexual material.

 I hereby release, discharge, and hold harmless Global Assets, LLC, it’s affiliates and its agents from any and all claims, demands, or causes of action that I may hereafter have by reason of anything contained in the photographs or video.

Please initial the following:

*I am above 18 years of age. Yes No
*I swear that I have disclosed my legal correct name.: Yes No
*I swear that I have disclosed all other names that I have been
 known by to REPRESENTATIVES.		 Yes No
*I swear I produced a legal identification card. Yes  No
*I swear that I have not provided any false or misleading
 information to REPRESENTATIVE.		 Yes No
*I swear that I will do nothing in violation of any local,
 state or federal laws, including any obscene, lewd or illegal act.		 Yes No
*I swear that I will bring no drugs, alcohol, or illegal substances
 onto Company’s premises or where performance is occurring. 		Yes No

I, the PERFORMER,* do hereby certify and swear under the declaration of perjury that the aforementioned is true and correct by my signature and that I agree with such terms.I hereby represent that I am eighteen years of age or older, and that I was eighteen years of age or older at the time the Product wascreated. I further represent that I provided valid and correct identification documents to the Representatives that are accurate and that a photocopy or photograph of each identification document is attached to this Release Agreement.

*Performer Signature (Full Name):
*Upload Photo ID: (10MB Max File Size)
*Upload Photo of ID held next to face (10MB Max File Size)
*Date:

UNDER 28 U.S.C. 1746 AND THE PENALTY OF PERJURY UNDER THE LAWS OF THE UNITED STATES I SWEAR THAT THE AFOREMENTIONED IS TRUE AND CORRECT, THAT I HAVE EXAMINED THE PERFORMERS PHOTO IDENTIFICATION AND DATE OF BIRTH, AND THAT I HAVE OBSERVED THE ORIGINALS OF EACH OR THE IDENTIFICATION DOCUMENTS OF WHICH COPIES HAVE BEEN ATTACHED HERETO SIGNED BY THE PERFORMER. IN ADDITION, I SWEAR THAT THE DATE SET FORTH BELOW IS THE DATE WHEN THESE WERE OBSERVED.

Global Assets, LLC and Affiliates Representative