Media Release Request Form

MEDIA RELEASE REQUEST FORM

Requester Name:     Requester Entity Type: Individual Company

Subject Name:     Date of Birth:

Recitals (Whereas)

WHEREAS, Requester desires to photograph, record, reproduce and use the image, likeness, voice, performance and biographical material of the Subject in connection with the production described below; and

WHEREAS, Subject is willing to grant Requester the rights set forth in this Agreement in consideration of the promises and compensation set forth herein.

Production Details

Scheduled Recording/Shoot Date:

Media Types Requested: Photography Video Audio Digital/Online Print

Scope of Work

Describe the services, deliverables and intended uses to be performed by Requester and permitted for use of Subject's likeness. Include any deadlines, territories and formats.

Grant of Rights and Release

Subject hereby grants Requester and Requester's licensees, successors and assigns a perpetual, worldwide, royalty-free, transferable right and license to record, reproduce, publish, distribute, display, edit and otherwise use Subject's name, likeness, voice, image and performance in any media now known or hereafter developed for the purposes described in this Agreement. Subject waives any rights of inspection or approval and releases Requester from any claims for invasion of privacy, defamation, or publicity arising from such uses to the extent permitted by law.

Payment Terms

Payment Amount: $

Late Payment Fee: . All late fees accrue from the date payment is due until paid in full.

Term and Termination

Term Commencement Date:

Term End Date (if any):

Either party may terminate this Agreement for material breach by the other party, provided written notice is given and the breaching party fails to cure within the notice period specified above. Termination does not affect accrued rights or obligations, including licenses granted prior to termination.

Confidentiality

The parties acknowledge that certain information exchanged in connection with this Agreement may be confidential. Neither party will disclose or use Confidential Information of the other except to perform its obligations hereunder, except where disclosure is required by law or information is already publicly known through no fault of the receiving party. Confidential Information does not include material independently developed or rightfully obtained from a third party.

Representations, Indemnity and Warranties

Each party represents that it has the full right, power and authority to enter into this Agreement. Subject represents that use of Subject's likeness as permitted herein will not violate the rights of any third party. Subject agrees to indemnify, defend and hold Requester harmless from any claims, liabilities or expenses arising from breach of such representation.

Credit and Attribution

Any credit or attribution to Subject for use in the Production will be provided as follows:

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the state or jurisdiction specified by Requester: , without regard to conflict of law principles.

Entire Agreement

This Agreement, together with any exhibits or attachments executed contemporaneously, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior and contemporaneous agreements, proposals, negotiations and communications, whether oral or written. No amendment is effective unless in writing and signed by both parties.

Additional Provisions

Permission to edit, retouch or alter material: Yes    No

Sign Now