Required Form for Starlet Project:

Legal Name

First Name

Last Name

Nick Name or Alias

First Name

Last Name

Subject

Just Fill In With The Word "Starlet."

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Birthdate

YYYY

Occupation-If you are retired say Retired From XXXXX

Why you wanted to take part in this project:

List any Dietary Restrictions Here:

What do you prefer to drink?

Are you allergic to any specific makeup products?

Release:

Click the CheckBox Below and Type Your Name in the Field Below to Electronically Sign The Release

In consideration of value received, I do hereby give to Humans of Central Appalachia, Malcolm J. Wilson, his or her assigns, legal representatives, and heirs the irrevocable right to use my name, audio recording of my voice, portrait or photograph in all forms and media (including composite representations) for any lawful use. I waive my right to inspect or approve the finished version(s).

Checkbox

I agree to the terms listed above.

Electronic Signature (Legal Name)

First Name

Last Name

Required Form for Starlet Project:

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