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
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
