DONNA FLOR

Bikini Gallery

BIKINI GALLERY APPLICATION

How to participate of Bikini Gallery - Print and complete this form, sign below and send by fax: 1-305-351-8473 USA. - Send your pictures ever you want, by e-mail to this address: customer@donnaflor.com including your nickname on Bikini Gallery.

PERSONAL INFORMATIONS

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FULL NAME

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ID CARD

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STATE OF ISSUE

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PASSPORT

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FULL ADDRESS

FULL ADDRESS (Cont.)

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CITY

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COUNTRY

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ST

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AREA

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PHONE

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CELL PHONE

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FAX

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DATE OF BIRTH

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e-MAIL ADDRESS:

AGREEMENT OF IMAGE USE

I hereby declare for all legally purposes who I have AUTHORIZED the publication of the set of pictures sent by me at http://gallery.donnaflor.com to expose at the Bikini Gallery, promotions and advertising of Donna Flor products. I Authorize the Donna Flor (between any of your companies) to use the pictures, without any cost or compensation, by the term of 1 (one) year. Declare to have 18 years or old.

BIKINI GALLERY INFORMATIONS

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PLACE WHERE THE PICTURES ARE SHOOTED

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NICKNAME TO BIKINI GALLERY

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PLACE

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DATE

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SIGNATURE