In compliance with 18 U.S.C. 2257 and applicable record-keeping requirements, the performer certifies that they are at least 18 years of age and has provided valid government-issued photo identification for age verification.
The performer understands that a completed IRS Form W-9 is required for payment and tax reporting purposes.
I, the undersigned performer, voluntarily consent to be photographed, recorded, filmed, livestreamed, or otherwise captured by the Company / Producer named above. I authorize the Company, its successors, licensees, assignees, affiliates, distributors, and representatives to use, reproduce, publish, display, distribute, edit, license, sell, and create derivative works from my image, likeness, voice, performance, name, stage name, biographical information, and related content in any lawful media now known or later developed, worldwide and in perpetuity.
I understand that I will not receive additional compensation unless agreed in a separate written agreement. I confirm that my participation is voluntary and that I am not under duress, coercion, or the influence of any substance that would impair my ability to consent.
I understand that required records may be maintained by the custodian of records as required under 18 U.S.C. 2257 and 28 C.F.R. Part 75. I certify under penalty of perjury that the identification and information I provided are true, accurate, and belong to me.
By signing this form electronically, I agree that my electronic signature, typed name, checked boxes, uploaded documents, and related electronic actions are intended to authenticate this form and are legally binding to the same extent as an original handwritten signature, including under the federal ESIGN Act and applicable state UETA laws. I consent to receive, sign, and store this form electronically.
I certify that I have reviewed this entire form, that all information is true and correct, and that I have had the opportunity to ask questions before signing.