Photo and Video Release Please enable JavaScript in your browser to complete this form.Name *FirstLastCompany Name *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Photo and Video Release Consent *I have read and accepted the below terms and conditions.By checking the box above you agree to the following statement. I hereby grant permission to Darcy Mehta, Vivacity Productions, and Freshly Squeezed, the absolute and irrevocable rights to my image, likeness and sound of my voice as recorded on camera, audio or video tape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I acknowledge that the images may be used, without limitations, in print publications, online publications, websites, and on social media.Date / Time This Form Is Filled Out *DateTimeSubmit