Dear SkinnyBox EmailThis field is for validation purposes and should be left unchanged.Dear SkinnyBox(Required)Are 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 SkinnyBoxâ„¢, 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 SkinnyBoxâ„¢, 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)Your NameYour NameYour NameYour NameAddress(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)Your NameYour NameYour NameYour NameLegal 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 URLThis field is for validation purposes and should be left unchanged.Dear SkinnyBox(Required)Are 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 SkinnyBoxâ„¢, 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 SkinnyBoxâ„¢, 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)Your NameYour NameYour NameYour NameAddress(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)Your NameYour NameYour NameYour NameLegal 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
