Talent release form

Date _______________________________________________________

Program ____________________________________________________

Producer ____________________________________________________

In consideration of your plan to produce the above captioned program and as an inducement to permit me personally to appear on the cablecast of the program, I hereby consent to the use of my name, likeness, pictures and/or voice by you and your licensees for cablecasting, direct exhibition, and subsidiary purposes. Such uses will not be made as will constitute a direct endorsement by me of any product or service.

I hereby idemnify you and your licensees respecting my claim or action against you, your licensees or your officers and agents, arising out of my acts or statements out of the program.

Signature ___________________________________________________

Print name __________________________________________________

Witness _____________________________________________________

If minor, guardian _____________________________________________

Talent release form

Date _______________________________________________________

Program ____________________________________________________

Producer ____________________________________________________

In consideration of your plan to produce the above captioned program and as an inducement to permit me personally to appear on the cablecast of the program, I hereby consent to the use of my name, likeness, pictures and/or voice by you and your licensees for cablecasting, direct exhibition, and subsidiary purposes. Such uses will not be made as will constitute a direct endorsement by me of any product or service.

I hereby idemnify you and your licensees respecting my claim or action against you, your licensees or your officers and agents, arising out of my acts or statements out of the program.

Signature ___________________________________________________

Print name __________________________________________________

Witness _____________________________________________________

If minor, guardian _____________________________________________

M A K E M E AStar!

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Panasonic AG-HMC150 manual Talent release form, Date Program Producer