Please read, fill out and submit the release form below.
Program: "Ask the Experts" Filming (“Program”)
Program Filming Date: Tuesday April 30, 2013
Filming Location: San Diego, CA
I hereby authorize Home Planet Productions, Chaucerbury Corp., and the American Foundation for Suicide Prevention (“Producers”) to record my name, likeness, image, voice, and performance on film, tape or otherwise for use in the above Program or parts thereof. I agree that the Program may be edited and otherwise altered at the sole discretion of the Producers and used in whole or in part for any and all broadcasting, audio/visual, and/or exhibition purposes in any manner or media, in perpetuity, throughout the world. I understand that I have no rights to the Program or any benefits derived therefrom.
I consent to the use of my name, likeness, voice, and biographical material about me in connection with the promotion of the Program.
I represent that I have the right to enter into this agreement (the “Agreement”) and that my performance and the rights I have granted in this Agreement will not conflict with or violate any commitment or understanding I have with any other person or entity.
I agree to indemnify and hold harmless Producers from and against all claims, losses, expenses and liabilities of every kind including reasonable attorney’s fees arising out of the inaccuracy or breach of any provision of this Agreement. I expressly release Producers from any and all claims arising out of the use of the Program.
This Agreement represents the entire understanding of the parties and may not be amended unless mutually agreed to by both parties in writing.
American Foundation for Suicide Prevention
120 Wall Street, 29th Floor
New York, NY 10005