Name *

First Name

Last Name

Phone *

(###)

###

####

What date are you available to shoot? *

MM

DD

YYYY

If yes, What borough do you Rep?

Brooklyn

Queens

Manhattan

The Bronx

Staten Island

Nassau/Suffolk County

Not in 5 boroughs

What Themes are you interested in shooting?

Select up to 3

Beauty/Glamour Portraits

Fashion Portraits

Lifestyle Sessions

Cosplay

Vixen

Group Portraits

Budoire

Do you have your own MUA?

Yes I got this

No, I need help

Are you able to style your own shoot?

Yes

No

What is your modeling experience?

I'm new to this

I am a Selfie queen

I can make Any situation look good

Model Release Consent *

For valuable consideration, I hereby grant LK Supreme Media Studio the absolute and irrevocable right and permission with respect to the photographs that he has taken of me during this session in which he/she may be included with others: a. To copyright the same in LK Supreme Media Studio name b. To use, re-use, publish and re-publish the same in whole or in part, separately or in conjunction with other photographs, in any medium now or hereafter known, and for any purpose whatsoever, including (but not by way of limitation) illustration, promotion, advertising and trade, and; c. To use my name in connection therewith if he so decides. I hereby release and discharge LK Supreme Media Studios from all and any claims and demands ensuing from or in connection with the use of the photographs, including any and all claims for libel and invasion of privacy. This authorization and release shall inure to the benefit of the legal representatives, licensees and assigns of photographer LK Supreme Media Studios as well as the person(s) for whom he/she took the photographs. I have read the foregoing and fully understand the contents hereof. I represent that I am the above named model. For value received, I hereby consent to the foregoing on his/her behalf.

I consent

I do not agree