Actor's Release Form
AUTHORIZATION TO REPRODUCE PHYSICAL LIKENESS AND/OR VOICE
I hereby irrevocably grant to __________________ (herein "Producer") and any parent, subsidiary and
affiliated corporations and their respective successors, assigns, licensees, employees and agents, the right in
perpetuity thoughout the universe, and in all now known and hereafter existing media, and in any language,
to use my name (including any fictitious names heretofore or hereafter used by me), physical likeness
and/or voice in and in connection with the production, exhibition, exploitation, merchandising, advertising
and promotion of the motion picture tentatively entitled ___________ (the "Picture").
I agree that the foregoing grant includes the right to use my physical likeness in any form, including,
without limitation, a photograph, picture, artistic rendering, silhouette or other reproduction by photograph,
film, tape, or otherwise.
I represent to the best of my knowledge that the consent of no other persons, firm corporation or labor
organization is required to enable Producer to use my name, likeness and/or voice as described herein and
that such use will not violate the rights of any third parties.
I acknowledge that nothing herein requires Producer to use my likeness and/or voice as described herein or
in connection with the Picture.
The rights granted herein include the right to use the Picture or excerpts or stills form the Picture (include
excerpts or stills containing my likeness and/or voice) in any other motion picture, publication, recording,
or other medium and includes the right to edit, delete, and/or juxtapose (with any other part of the Picture),
any part of the Picture in which I appear, and/or change the sequence of events in the Picture.
All rights, title and interest in and to the results and proceeds of the services and performances rendered by
me in connection with the production of the Picture or any portion therefor shall, from its inception, be the
sole property of Producer, free from any claim whatsoever by me or any other person.
This agreement contains the full and complete understanding between the parties and supersedes all prior
agreements and understandings pertaining hereto and cannot be modified except by writing signed by each
party.
I hereby certify and represent that I am of legal age and have every right to contract in my own name in
connection with this Release, and that I have read the foregoing and fully understand the meaning and
effect thereof, and intending to be legally bound I have signed this Authorization this ________ day of
____________________, 2002.
__________________
Print Name
__________________
Signature
__________________
Address
__________________
Date