I, hereby confirm the consent therefore given you with respect to your photographing me in
connection with the DVD, and I hereby grant to you, your successors, assigns and licenses the perpetual right to use, in any manner or in any media currently existing or which may be developed in the future, as they may desire, all video, still and motion
pictures and sound track recordings and records which you may make of me or of my voice, and the right to use my
name or likeness in or in connection with the exhibition, advertising, or any other use of such motion
picture or recording.
I understand that I might not be provided with a copy of the film on DVD for my personal use only. I will not seek compensation from the creators/producers for my involvement in this project. I will not sell said copy or use it for any commercial purposes such as broadcasting, streaming online or Home Video-DVD releases.
I also understand that it takes a significant amount of time to complete a film – and in some cases projects are
abandoned and not completed at all. If the filmmaker has promised a tape of the film I agree to allow a
reasonable amount of time to elapse after the performance for completion. I agree that should the
DVD not be completed I will take no action against creators/producers.
Signature : _______________________________
Name (Print) : _____________________________
Phone Number : ___________________________ E-mail:________________________Date : _____________ release form revised 11/05/09