Extra Release Form

EXTRA RELEASE FORM

KC Productions

Title: Motive For Murder

Producer: Julien Zephir

 

55 Richmond Rd,

Kingston upon Thames

KT2 5BP

 

020 8939 4601

I (the undersigned) do hereby confirm that I have agreed to be filmed and photographed as an extra (non-speaking role) in connection with the film Motive for Murder on the 2nd January 2017

I hereby grant to you, your successors, assigns and licensees, to use as you desire in any manner or in any media currently existing or which may be developed in the future, all video, still and motion pictures that you may take of me.

I understand that I shall receive [no fee/ a fee of £x] for my appearance in and participation in the film.

I am over 18 years of age

Signed …………………………………..

Print   …………………………………..

Print Name

 

 

 

 

 

 

 

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