Kingpin College Photo/Description Submission Form

Your name: _________________ Your email: ________________

Your mailing address____________________________________

City, ST, Zip________________________________

Mail this form with actual paper photo(s) or CD with photo file(s) to:
In-Stone, 519 Interstate-30 #228, Rockwall, TX 75087.

By submitting photos you agree to our MODEL RELEASE AND CONSENT AGREEMENT:
I irrevocably consent to the use by Kingpin and its successors of all images submitted for advertising and promoting Kingpin hats. This agreement constitutes the sole, complete and exclusive agreement between the parties.

Kingpin College Degree Questionaire

PhD desired(Check one): Beanie Avionics______ or Beanie Design________

Full name with middle initial on diploma: _____________________________

OPTIONAL: Describe any special details about the picture(s) submitted like "At Disneyworld", "In the Price is Right studio audience" or whatever: