BLAQUELINE Magazine
  • The Confident Man Interview Form

    SUBMISSION FORM: Please complete the information below to be considered for inclusion in the BLAQUELINE Magazine Confident Man publication. As part of The Confident Man magazine publication and interview, you will have a photo shoot and answer a few questions on camera about what it means to be a confident man as well as provide advice to men that may want tips to be more confident.Complete the quick form below and if you are selected you will receive an email confirmation. You must include a photo with this form. **Note:  You must be 21-years of age to be part of The Confident Man publication
  • Contact Info

    Please fill in your contact details
  • Photos (required)

    Please upload 1 photo of yourself. DO NOT INCLUDE INAPPROPRIATE PHOTOS.
  • Upload a File
    Cancelof
  • MEDIA RELEASE

    I hereby grant permission to the rights of my image, likeness and sound of my voice as recorded on audio or videotape, 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 also understand that this material may be used in diverse commercial settings within an unrestricted geographic area.

    Photographic, audio or video recordings may be used for the following purposes:
    commercial presentations
    online music video platforms (YouTube, Vimeo, etc)
    television or broadcast media distribution
    social media platforms

    By signing this release I understand that photographic or video recordings of me may be electronically displayed via the Internet or in the public business settings.

    I will be consulted about the use of the photographs or video recording for any purpose other than those listed above.

    There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.

    This release applies to photographic, audio or video recordings collected as part of the sessions listed on this document only.

    By signing this form I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for entertainment purposes.

  • Reload
  • Should be Empty: