release form

USE OF NAME AND IMAGE

Project Name___________________________________

Production Company______________________________

Address_______________________________________

Date:_________________________________________

I, the undersigned, hereby grant permission to ________________________ ("Producer") to photograph me and record my voice, performance, poses, and appearances, and use my picture, photograph, silhouette, and other reproductions of my physical likeness and sound as part of the ________________________________ tentatively entitled ________________________ ( the "Picture") and the unlimited distribution, promotion and exhibition of the Picture by any method or device known or hereafter devised in which the same may be used, and/or incorporated and exhibited.

I agree that I will not assert or maintain against you or your successors any claim, or action, suit, or demand of any kind or nature whatsoever, including but not limited to, those grounded upon invasion of privacy, rights of publicity or other civil rights, or for any other reason in connection with your authorized use of my physical likeness and sound in the Picture as herein provided. I hereby release you and your successors from and against any and all claims, liabilities, demands, actions, costs and expenses whatsoever, at law or in equity, which I ever had, now have, or may, shall or hereafter have by reason, matter, cause or thing arising out of your use as herein provided.

I have read the foregoing and fully understand the meaning and effect thereof and, intrending to be legally bound, I have signed this release.

Agreed and Accepted to

____________________

PRINT NAME

____________________

SIGNATURE

____________________

____________________

ADDRESS

____________________

PHONE NUMBER

BY__________________