16.2.5 - Release forms

Release Form

Production Company

Name and address of Contributor:

           

Date:

The Name of the Film (working title)

I agree to the inclusion of my contribution in this film, the nature of which has been explained to me.  I understand that my contribution will be edited and there is no guarantee that my contribution will appear in the final film. I agree that my contribution may be used to publicise the film.

I have agreed to accept no payment for the use of my contribution.  This fee is payable on completion of the interview.

I understand that this film (or part of it) may be distributed in any medium in any part of the world.

My contribution has, to the best of my knowledge, been truthful and honest.  I have not deliberately sought to conceal any relevant facts from the makers of this film.

Signed ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­