Actor Release

I (the undersigned) do hereby confirm the consent heretofore given you with respect to your photographing me in connection with your video:

Title/Description____________________________________________________

and I hereby grant to you, your successors, assigns and licensees the perpetual right to use, as you may desire, all video, still and motion pictures and sound track recordings and records which you may make of me or of my voice, and the right to use my name or likeness in or in connection with the exhibition, advertising, exploitation or any other use of such motion picture or recording for the following monetary consideration:

Check all that apply:
_____	$___.00 per day for ___ days total
_____	$___.00 – Flat rate ___ days total
_____	Copy of CD/DVD/Digital Video
_____	Other: ______________________________________________

I also understand that it takes a significant amount of time to complete a film – and in some cases films are abandoned and not completed at all. If producer/filmmaker has promised a CD/DVD/Digital Version of the film I agree to allow a reasonable amount of time to elapse after the performance for completion (i.e. six months). 

	___	I am over eighteen years of age	 
Signature:	_____________________________________________	
Name (print) ____________________________________________
Address	_____________________________________________
		_____________________________________________
Phone:	_______________  e-mail: _______________________		                                                                                                                                        
PRODUCER/FILM MAKER
Signature:	_____________________________________________	
Name (print) ____________________________________________
Address	_____________________________________________
		_____________________________________________
Phone:	_______________  e-mail: _______________________