I hereby authorize USWebGirls to advertise with photos I have provided or have had taken.
I verify that: These photos are of me; and I am at least 18 years of age; and I have exclusive rights to
the photos and/or videos which I have provided. Furthermore, USWebGirls will not be held liable for any
and all claims resulting from the use of these photos in my advertisement. I understand that photos used
by USWebGirls may not be copied, duplicated or reproduced without written approval of USWebGirls.
I have complete control over when my picture(s) are taken off the site and are no longer to be used.
Name: __________________________________________________
Address: ________________________________________________
City: _______________________ State: _______ Zip: ____________
Phone: __________________________________________________
Email: ___________________________________________________
Signature _________________________________________
Date _____________________________________
Please Print, Fill Out
Form, Scan and then Email to advertising@uswebgirls.com