SCM

RELEASE

AUTHORIZATION TO REPRODUCE PHYSICAL LIKENESS

TALENT, SERVICES AND ADVERTISING RELEASE

DATE_______________

For value received, I agree and consent that __________________________________________ and its nominees and assigns may use any motion pictures, still photographs, videotape recordings, magnetic tape recordings, optical recording, taken of me on ___________________ or any reproduction thereof, in any form, style or color, together with any writing and/or other advertising and/or publicity material in connection therewith, including the use of my name, as they may select.

I understand that my talents and/or services and any related advertising and publicity materials are to be used in connection with _________________________________________________.

This consent and release is given by me without limitations upon any use for projection, playback, reprints, rerun, broadcast, telecast, or publication of every kind, including the advertising and publicity connected therewith. I also agree that the originals and copies therefore shall be and remain in the exclusive property of _______________________________ or its nominees and assigns.

I am over eighteen (18) years of age, (If subject is under 18, a parent or guardian must sign this release on behalf of the minor),

• Sign X:

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• Address:

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• Phone:

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• Witness: ____________________________________________________________________________________

• Sign X:

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• Address:

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• Phone

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• Witness:

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• Sign X:

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• Address:

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• Phone:

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• Witness:

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