Interviewee Release Form

For consideration that I acknowledge, I consent to the recording of my statements and grant to _________________________ (the "Company") the right to copy, reproduce, and use all or a portion of the statements (the "Interview") for all purposes, including advertising, trade, or any commercial purpose throughout the world and in perpetuity, in any media including but not limited to Internet, audio and video cassettes, CD-ROM, DVD, television, radio and cable broadcast and print.

I grant to the Company all copyrights to the Interview, in its name or any other name it may choose, and acknowledge the Comany as the exclusive owner of any and all right, title and interest in the finished work(s).

I grant to the Company the right to use my image, voice, name and biographical information in connection with all uses of the Interview. I expressly release the Company from any defamation and other claims I may have arising out of the above-described materials and waive the right to inspect or approve any use of my Interview.

I agree that this consent and release is binding upon me and my heirs, legal representatives and assigns and is for the benefit of the Company and its agents, employees, assigns, licensees, and successors.

Name (Print):______________________________
Signature:_________________________________
Date:_____________________
Phone (optional)___________________________
Address _______________________________

PARENT OR GUARDIAN SIGNATURE REQUIRED IF THE INTERVIEWEE IS UNDER THE AGE OF 18

Name (Print):______________________________
Signature:_________________________________
Relationship to Interviewee:________________________
Date:_____________________