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]
