Fill and Sign the Release Person Form

Release by Person Appearing in Program I, ______________________ (Name of Releasor) , of ___________________________ ___________________________________________ (street address, city, state, zip code) , hereafter called Releasor, do hereby enter into this Agreement with ______________________ ( name of production company) , a corporation organized and existing under the laws of the state of _______________, with its principal office located at ___________________________ ____________________________________________ (street address, city, state, zip code) , hereinafter called Producer, which is producing a program entitled _______________________ (name of program) , for which my (e.g., name, voice, likeness, photograph, image, biography, or performance) ____________________________ has been recorded. 1. I hereby grant to Producer , and its designees and successors, the right to use the recordings of my (e.g., name, voice, likeness, portrait, picture, photograph, image, biography, or performance) ___________________ in its productions; to edit, mix, duplicate, alter, use or reuse, in whole or in part, such recordings; to transfer such recordings onto other media, including, but not limited to, ( e.g., videotape, film, photographs, audiotapes, slides) _______________________. 2. I hereby grant to Producer the right to broadcast, market and distribute the recordings, in whole or in part, alone or as part of its finished production, for presentation on commercial, noncommercial, or closed circuit television. 3. I hereby grant permission to Producer to use my (e.g., name, voice, likeness, portrait, picture, photograph, image, biography, or performance) __________________ as recorded in its production, for promotional or publicity purposes of the program. 4. I hereby release Producer , its officers, employees and agents from any and all claims, known or unknown, arising out of or in any way connected with the uses described in this agreement. WITNESS my signature as of the day and date first above stated. _________________________ (P rinted name) _________________________ (Signature of Releasor)