THE FILM: “Film Title”
In consideration of payment of the sum of $1.00 (receipt acknowledged) OR an end credit in the Film, I hereby irrevocably authorize and grant to the Jim Smith/Wang Dang Productions ("hereinafter the Producer" which includes its successors and assigns) the right to:
1. Record me (picture and/or voice) on photographs, film and/or video tape, for audio only, audio and visual and/or visual only reproduction ("the Recording");
2. Edit the Recording into a film/television program (which may include other recordings and material);
3. Use my name and likeness, voice, biographic or other information concerning me;
4. Screen and broadcast the Recording in the Film; and
5. Use and license others to use the Recording in all media throughout the world for the full period of copyright, including for the purposes of publicity, advertising, sales and promotion of the Film.
Other material: I also grant the Producer a non-exclusive license to use the following material in the Film: (e.g. personal papers, manuscripts, photographs, memorabilia, footage, musical works)
I hereby release the Producer from any infringement or violation of personal and/or property rights of any sort whatsoever based upon the use of the Recording.
I acknowledge that the Producer owns and shall own all rights, title and interest (including copyright) in the Recording.
I further acknowledge that the Producer is not obliged to use the Recording.
I warrant that I have full power to enter into this Release and that the terms of this Release do not in any way conflict with any existing commitment on my part. Reference to "the Recording" in this Release includes any and all edited versions made by the Producer and also includes any previously recorded material of me made by the Producer.
Agreed and accepted by the Releaser
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(sign above)
Print Name: ______
Address: ______
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Producer Date