Actor Consent

Actor / Contributor Consent form

 

With reference to the following production:

Produced by: Marcia precious

 

* In consideration of the sum of £…50……now paid to me (receipt of which is hereby acknowledged), I agree to the recording and copying and / or broadcasting of the performance / interview / contribution given by me to you on …04……./…02……./2011……. This agreement allows ‘unlimited’ future copying / broadcasting of the said material without any further payment.

* In consideration of the non-remuneration agreement between myself and Harrow College Media Productions I consent to the interview / contribution given by me to you on …04……./…02……./…2011……. giving over ‘unlimited’ rights to the above named production company.  This agreement also allows ‘unlimited’ future copying / broadcasting of the said material without payment.

* Delete / fill in as applicable

This agreement enables the above named producer / production company to exploit the performance / interview / contribution, which I hereby give my consent, in any contemporary or future audio-visual media throughout the territories of the United Kingdom and the rest or the World. 

Name (Please print):   Naila nurudin                                                               Date: 04/02/2011

Address: 53 Maple Avenue

                  West Drayton

                    middlesex

                 ub7 8lt

Contact telephone number: 07986 441 324

Signature: N.P.H.nurudin