Name or Nickname:
Date of Birth:
I certify that I am at least 18 years of age.
I realize that I cannot win any prizes if
you have no way of contacting me.
I will be sending a picture of myself to
You have my permission to place the
picture(s) I send in the OSDP Gallery.
Please feel free to provide us with any additional information or comments that you desire:
Please include my comments with my picture in the OSDP gallery.