Dear SkinnyBox Dear SkinnyBox(Required)This field is hidden when viewing the formAre you uploading your before and after pictures?NoYesUpload Pictures Here(Required) Drop files here or Select files Max. file size: 8 MB. ReleaseI grant full permission to SkinnyBox™, LLC to and its employees and contractors the irrevocable and unrestricted right to reproduce the photographs and videos taken of me, or members of my family for production, promotion, illustration, advertising, or trade in any manner or in any medium. I hereby release SkinnyBox™, LLC and its legal representatives for all claims and liability related to said images or video content. Furthermore, I grant permission to use my statements that were given during an interview, guest lecture or written testimonial statement with or without my name, for advertising and publicity without restriction. I waive my right to any compensation.I acknowledge that I am(Required) over 18 years of age the legal guardian of the following Please select the appropriate option.Name(Required) First Last Email(Required) Signature(Required)Address(Required) Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code If applicable:Legal Guardian Name(Required) First Last Legal Guardian Signature(Required)Legal Guardian Address(Required) Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CommentsThis field is for validation purposes and should be left unchanged. Dear SkinnyBox(Required)This field is hidden when viewing the formAre you uploading your before and after pictures?NoYesUpload Pictures Here(Required) Drop files here or Select files Max. file size: 8 MB. ReleaseI grant full permission to SkinnyBox™, LLC to and its employees and contractors the irrevocable and unrestricted right to reproduce the photographs and videos taken of me, or members of my family for production, promotion, illustration, advertising, or trade in any manner or in any medium. I hereby release SkinnyBox™, LLC and its legal representatives for all claims and liability related to said images or video content. Furthermore, I grant permission to use my statements that were given during an interview, guest lecture or written testimonial statement with or without my name, for advertising and publicity without restriction. I waive my right to any compensation.I acknowledge that I am(Required) over 18 years of age the legal guardian of the following Please select the appropriate option.Name(Required) First Last Email(Required) Signature(Required)Address(Required) Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code If applicable:Legal Guardian Name(Required) First Last Legal Guardian Signature(Required)Legal Guardian Address(Required) Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code EmailThis field is for validation purposes and should be left unchanged.
