Media Interview Form

MEDIA INTERVIEW FORM

This Media Interview Agreement (the "Agreement") is entered into by and between the parties identified below for the purpose of recording, publishing, and otherwise using statements, images, and other materials arising from a media interview. Media Organization Name: Interviewer Name: Interviewee Name:

RECITALS

WHEREAS, the Media Organization desires to conduct an interview with the Interviewee concerning topics related to the Interviewee's expertise, activities, or affiliations; and

WHEREAS, the Interviewee is willing to participate in the interview under the terms set forth in this Agreement, including granting specified rights to record, reproduce, distribute, and publicly display the interview materials; and

WHEREAS, the parties desire a written record of agreed scope, compensation, and usage rights to avoid misunderstandings.

SCOPE OF WORK

Interview Date:   Start Time:   Estimated Duration:

INTERVIEW DETAILS

Medium:   Live or Recorded:

RECORDING, USE, AND RELEASE

The Interviewee hereby authorizes the Media Organization and its assigns and licensees to record, photograph, film, transcribe, edit, reproduce, distribute, publish, and otherwise use the Interviewee's name, voice, likeness, statements, and biographical information in connection with the Interview (collectively, "Materials") in all media now known or hereafter devised, in perpetuity, worldwide. This authorization includes the right to use the Materials for promotion, advertising, syndication, archival, and derivative purposes.

Permission to record (check all that apply): Audio Video Photographs

Transcript review request: Interviewee requests to review transcript prior to publication (if selected, any agreed review period and changes must be set out below)

PAYMENT TERMS

Compensation Amount:   Payment Schedule:

Late Payment: Any overdue payment shall accrue interest at the rate of or the maximum rate permitted by law, whichever is less. If payment is contingent on publication, the Media Organization will provide written notice if publication will not occur within 60 days.

TRAVEL AND EXPENSES

Travel and reasonable expenses will be reimbursed as follows:

CONFIDENTIALITY

Unless otherwise agreed in writing, the parties acknowledge that the Interviewee may disclose non-public information during the interview. The Media Organization agrees not to use or disclose any information the Interviewee has designated in writing as confidential, except as required by law or as necessary for the preparation, editing, and publication of the Interview. Confidential information does not include information that (a) is or becomes public through no breach of this Agreement, (b) is already known to the recipient without restriction, or (c) is lawfully obtained from a third party without restriction.

TERM AND TERMINATION

This Agreement commences on the Start Date: and terminates on the End Date: unless earlier terminated in accordance with this section.

Either party may terminate this Agreement for any reason on written notice to the other party delivered at least days prior to the effective termination date. Termination will not relieve either party of obligations accrued prior to the effective date of termination, including payment obligations.

REPRESENTATIONS, WARRANTIES, AND INDEMNITY

Each party represents and warrants that it has the full right, power, and authority to enter into this Agreement and to grant the rights granted herein. The Interviewee represents that statements provided are truthful to the Interviewee's knowledge. The Interviewee agrees to indemnify and hold harmless the Media Organization from any third-party claims arising from false statements knowingly made by the Interviewee or from the Interviewee's breach of this Agreement.

GOVERNING LAW

ENTIRE AGREEMENT; AMENDMENT

This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, and representations. Any amendment or modification must be in writing and signed by authorized representatives of both parties.

MISCELLANEOUS

If any provision of this Agreement is held invalid or unenforceable, the remaining provisions will remain in full force and effect. Neither party may assign its rights or obligations under this Agreement without the prior written consent of the other, except that the Media Organization may assign to an affiliate or successor entity.

CONTACT INFORMATION

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