http://www.ModelonaBottle.com      

Please provide the following contact information:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
URL

What Screen Name or Alias would you like to use for your Page and Model on a Bottle Brand?

Please identify and describe yourself:  If applicable.

Name
Date of Birth
Sex	Male Female
Height
Weight
Hair Color	Blonde Brown Black Red Gray White
Eye Color	Blue Brown Black Green Gray Violet

Do you own the Exclusive Copyright or do you have copyright permission from the other Party (s) for the images you are submitting for display on Model on a Bottle Website and for future use on any Brand of Model on a Bottle Premium Waters of America Bottled Water Products?

I declare by Penalty of Perjury and subjection to legal prosecution for monetary and or other damages that I am the true legal owner of all images submitted to Model in a Bottle by filling in the Box below with my full legal Name  that I hear by give permission to Model on Bottle to host my Images online, create a web presence for me and make my images available for licensing or to make it known to Advertisers that they may hire a Photographer and or myself for featured images if I am not able to license any of the images I submit.   (There is a difference between owning pictures and owning the copyright.  You may post your pictures if you are in them or own them but you may not license them unless you own the copyright or have copyright permission.  Submitting your images for your online portfolio does not mean that you have agreed to license them.  It only means Advertisers can consider them and a separate agreement or contract will be presented if your images are selected.  I UNDERSTAND BY TYPING IN MY NAME BELOW.

I agree to hold harmless Model on a Bottle for any and all events and activities out of the normal course of business that could cause harm to me or my image.

"About Me" (What would you like this section of your webpage to say?

My Hobbies or favorite things to do are:

Highlights or Accomplishments of my  Career:

You can find me on these other PG Rated Websites: (List up to 5 with URL only) No links to Porn, Spam or Phishing permitted. No links to web pages with nudity permitted.

I would like to designate my images as:

Exclusive: I am the only one who can buy and sell.
Public: My brand but anyone can buy and sell.
Sponsored: I will share space.
Combination of any of the above.

I would like the following Contact Options listed on my webpage. (You may use Phone/Fax/PO Box/Manager/Agency or just email but whatever you use be sure you use something that protects you from Spammers, Stalkers or Phishers) yet enough that potential job contacts and fans can reach you.

I certify that I am full age (18 years old) and that I am possessed of full legal capacity to execute the forgoing authorization. I further state that for each image that is approved for my webpage and suitable for possible licensing and sponsorship that I either own the image, own the copyright or share the copyright and can supply proof if asked.