I, _________, hereby grant _________________ and its agents the right to video/audio tape my likeness/voice/performance and/or the likeness/voice/performance of ________________ (name of group), in connection with the production and distribution of the video/audio tape presentation named below, and that said video/audio tape may be broadcast or otherwise transmitted by ______________ its successors or assigns. I agree that you may copyright said video/audio tape.

I further agree that my name(s) likeness/voice(s) and biographical material may be used in connection with publicity about the production named below.

I understand that the recorded material will not be used for commercial gain, but excerpts may be used in compilations or other promotional activities. I release _____________ and their agents, successors and assigns from further claims or demands arising from the uses of materials you may record in which I/we appear or can be heard.

Production: _______________________________

Date: _________________________ Signature _________________________________

Address: __________________________________



Phone ___________________________________