Interviewee releases

1. FILM LION
INTERVEIWEE RELEASE FORM
I (the undersigned) hereby grant to Emily Judge the right to photograph me and to record my
voice, performances,poses, actions,plays and appearances, and use mypicture, photograph,
silhouette and other reproductions of my physical likeness in connection with the student
motion picture tentatively entitled News Wave.
I hereby certify and represent that I have read the foregoing and fully understand the meaning
and effect thereof.
Name: ___________________________________________
Signature: ________________________________________ Date: ____________
Telephone:_________________________ Email: ___________________________
PRODUCER NAME:__________________________________________________
PRODUCER TELEPHONE:_____________________________________________
PRODUCER EMAIL: __________________________________________________