Disclaimer
These forms are provided as is. Use of these forms do not create an attorney-client relationship. It is your responsibility to ensure the accuracy of these forms. Before using these forms confer with your own legal advisor.
Form A
Dear_,
You have informed me that you are the author of a book tentatively entitled ________ (the “Book”) to be published [by Publisher or about subject matter of book].
You have interviewed me for the Book, and I hereby consent to your use of my name, photographs, comments as quoted or derived from the interview(s), and any materials I provided to you, in the publication, advertising, or promotion of the Book, and any editions or revisions thereof, in any languages, throughout the world.
I hereby consent to your use of my name, likeness, and biography and the right to fictionalize same, and to portray, impersonate, or simulate me in any way whatsoever, and to make use of any incidents or episodes in my life, factually, fictionally, or in any combination thereof, in preparation, production, performance, broadcast, exhibition, and exploitation of one or more motion pictures or television programs, or both, including episodes of any television series (herein collectively referred to as the “program”), including, but not limited to, merchandising, publication, and other allied rights therein. You shall have the right to use the proceeds of any interviews in and in connection with the Book, and all services rendered by me hereunder (including my interviews and conversations) are rendered as a “work for hire” for copyright purposes.
I understand that the Book and/or portions thereof may be published in newspapers, magazines, and other printed media and may be released or distributed in other recorded media, such as television, motion pictures, computer disk, videodisc, and by other electronic means. I hereby consent to all such derivative uses, including the exhibition and publication in any and all media, now known or hereafter discovered throughout the world in perpetuity. Rights granted herein may be assigned to other individuals or entities.
I waive any right to inspect the Book or program(s). I further waive any claim in connection with the aforementioned use or uses, including, but not limited to, claims relating to defamation, rights of privacy or publicity, confidentiality, copyright, or otherwise.
I represent and warrant that I have full right, power, and authority to execute this Agreement, and I am over twenty-one years of age.
Very truly yours,
[Interviewee’s signature]
[Interviewee’s name]
[Address]
[Email Address]
Form B
Interview Release
For valuable consideration, receipt of which is hereby acknowledged, I hereby grant to ________ and their licensees, assigns, and successors the right to use all or any part of my statements, or any paraphrase thereof, and/or the right to describe and portray, in whole or in part, me and any events, episodes, or biographical information about me in their proposed work of [fiction/nonfiction] about [topic], presently entitled [title] in all its subsidiary and derivative publications (the “Work”), and for the advertising and promotion of the Work.
I understand that my name and likeness may or may not be used in the Work and related advertising and promotion, and I consent to the use or non-use of the same.
I hereby consent to the taping and other recording of any conversations and interviews in which I may participate. [Author] shall have the right to use the results and proceeds of any such conversations and interviews in and in connection with the Work, and all services rendered by me hereunder (including any interviews and conversations) are rendered as a “work made for hire” for copyright purposes.
I agree that I shall have no right, title, or interest in any such material (including the Work) and no claim of any kind whatsoever arising out of such use (including but not limited to any claims of libel, slander, invasion of privacy, invasion of right of publicity, and/or copyright infringement).
(a) I am over the age of twenty-one. I have read the foregoing and fully understand its contents.
Name:__Date:_
Signature:_
[If minor, parent or guardian must sign below]
(b) I represent that I am the parent or guardian of_,
a minor, and I further warrant that I am of full age and have the legal authority to execute the above release on behalf of said minor. I have read the release before signing it and am fully aware of its contents. This release shall remain binding upon me, our successors, assigns, legal representatives, and heirs.
Name:_Date:_
Signature:_
Father/Mother/Legal Guardian
Address:_
Email Address:_
Witness: [Optional] _
Minor’s full name: _
Minor’s address:_
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Related
Do I Need an Interview Release?
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