Entertainment Likeness Merchandising Consent Form

Entertainment Likeness Merchandising Consent Form
Please complete this form to authorize the use of your likeness for entertainment merchandising purposes.
Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Type of Likeness Authorized
Other
Please upload a photo or relevant media to be used for merchandising purposes.
Cancelof
Describe how your likeness will be used in merchandising (e.g., product type, campaign, etc.)
Duration of Consent
Will you receive compensation for the use of your likeness?
If yes, please specify the type and amount of compensation (if applicable)
Signature
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