Application Step 1 of 5 20% Name First Last Email Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Upload a selection of photos/videos of yourself* Drop files here or This will be shared with agencies and stakeholders This Release and Waiver is for the following Materials produced at any time in the future or past:* Photo(s), graphic(s), or other static artwork produced by, in coordination with, or for ESCENA. Film, video, or other moving artwork produced by, in coordination with, or for ESCENA. Music or sound recording(s) produced by, in coordination with, or for ESCENA. Select all Materials that apply. This is a release form that will allow you to designate ESCENA as the rights owner to the materials produced by, in coordination with, or for ESCENA. This agreement includes any past, current, or future projects produced by, in coordination with, or for ESCENA.I, the undersigned, hereby grant to ESCENA (https://escena.co) permission to use, exploit, adapt, modify, reproduce, distribute, publicly perform or display, in any form now known or later developed, the Material specified in this Release and Waiver as identified above (the “Materials”), throughout the world, by incorporating them into publications, catalogues, brochures, books, magazines, photo exhibits, motion picture films, videotapes, and/or other media (the “Works”) or commercial, informational, educational, advertising, or promotional materials relating thereto. I release, and hereby agree to indemnify, defend, and save harmless ESCENA, its agents, employees, licensees and assigns (collectively, “Released Entities”) from any and all claims I, or any third party, may have now or in the future for invasion of privacy, right of publicity, copyright infringement, defamation or any other cause of action arising out of the use, exploitation, reproduction, adaptation, distribution, broadcast, performance or display of the Materials. I further agree to indemnify, defend, and hold harmless the Released Entities from and against any lawsuit or cause of action against the Released Entities based upon, arising out of, or otherwise relating to the Materials, including without limitation, any cause of action relating to copyright infringement. I waive any right to inspect or to approve any Works that may be created using the Materials and waive any claim with respect to the eventual use to which the Materials may be applied. I understand and agree that ESCENA is and shall be the exclusive owner of all right, title, and interest, including copyright, in the Works, and any commercial informational, educational, advertising, or promotional materials containing the Materials. I understand I will not be compensated for use of the Materials, time spent in making the Materials, or have any right to any future royalties from or related to the use of the Materials. I am of full legal age and have read this Release and Waiver and am fully familiar with its contents. By their signature below, a minor’s parent(s) or legal guardian(s) indicate, on behalf of their minor child, their full and unqualified consent to the terms of this Release and Waiver. 184.108.40.206 - User IP logged for security. DATE: 09/22/2020 (FORMAT: M-D-Y) Sign Your Name*Please sign your name by tying your full name.