Name *

First Name

Last Name

Address *

Address 1

Address 2

City

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specific Date Requested *

What Wednesday or saturday are you requesting?

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DD

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I RELEASE MY RIGHTS FOR CHICAGO DEMO REEL PRODUCTIONS TO TAKE MY PHOTOGRAPH, VIDEO OF MY IMAGE OR VOICE RECORDING AND USE MY IMAGE TO PROMOTE THE CDR AND THEIR PROGRAM IN ANY WAY THEY SEE FIT WITHOUT LIMITATION. *