D. Franklin's conceptual art audience-activated performance piece entitled "TALENT/MODEL RELEASE FORM":
Instructions for participants in D. Franklin's conceptual art audience-activated performance piece entitled "TALENT/MODEL RELEASE FORM":
Print a copy of the form. Fill out Section 2, information about the talent/model. Whenever you are in the presence of any kind of camera (in your phone, your friends' phones, your computer, surveillance cameras in public or privately-owned spaces, drones flying overhead, etc.) that might be taking an image of you, display the form towards the lens of the camera. Try to display it at a distance and in a manner that it will be as legible as possible (this will require some guesswork regarding the lensing of the camera and whether the reader will be a human being or software).
TALENT/MODEL RELEASE FORM
[Production Company: please complete the information in the first section below in blue ball-point pen and return the completed form to the talent/model named below using the contact information supplied. Please use all capital block letters.]
1. Name of production company:
__________________________________________
Telephone: land line _________________________
Telephone: cell/mobile _________________________
Email __________________________________
Website __________________________________
Employer Identification Number (EIN) or Federal Tax Identification Number ____________________
Address where company is legally registered / incorporation address:
Street or PO Box__________________________________________
City _______________________
State/province/district _____________
ZIP/postal code _____________
Physical address or location of main business activities:
Street __________________________________________
City _______________________
State/province/district _____________
ZIP/postal code _____________
Type of company (circle one): LLC LP LLP PC S-corp
Government agency (please specify. Be as specific as the law permits): ____________________ )
Other (please specify: ____________________ )
Names of UBOs (ultimate beneficial owners) and responsible directors, managers, CEO, CFO, members of the board of directors, majority stake stockholders (attach additional sheets if necessary):
1. Surname: ______________________ Given name(s): ______________________
Cellphone/mobile: _________________________
Email: _________________________
2. Surname: ______________________ Given name(s): ______________________
Cellphone/mobile: _________________________
Email: _________________________
3. Surname: ______________________ Given name(s): ______________________
Cellphone/mobile: _________________________
Email: _________________________
[Talent/model: complete the information in the second section below before displaying the form to any cameras that may be recording your image.]
2. Full name of talent/model; ______________________________
I, [talent/model’s full name ____________________________________ ], being of legal age, hereby give [Production Company Name ____________________________________], their licensees, successors, legal representatives, and assigns the absolute and irrevocable right and permission to use my name and to use, reproduce, edit, exhibit, project, display, copyright, publish and/or resell photography images and/or moving pictures and/or videotaped images of me with or without my voice, or in which I may be included in whole or in part, photographed, taped, videotaped, and/or recorded on [today’s date __________________] and thereafter in perpetuity, and to circulate the same in all forms and media and printed matter for art, advertising, trade, competition, government surveillance of every description and/or any other lawful purpose whatsoever, to the degree that the lawfulness of such usage can be ascertained.
I hereby waive any right that I may have to inspect and/or approve the finished product or products or the editorial, advertising, or printed copy, accompanying text, digital files and other data, or soundtrack that may be used in connection therewith and any right that I may have to control the use to which said product, products, copy and/or soundtrack may be applied.
I hereby release, discharge and agree to save [Production Company Name ____________________________________], their licensees, successors, legal representatives and assigns from any liability by virtue of any blurring, distortion, alteration, optical illusion or use in composite form whether intentional or otherwise that may occur or be produced in the making, processing, duplication, projecting or displaying of said picture or images, and from liability for violation of any personal or proprietary right that I may have in conjunction with said pictures or images and with the use thereof.
AGREED AND ACCEPTED this [today’s date __________ ] of [month ___________ ], year 20____
[Optional] location ________________________________________________
Talent/model signature ________________________________
Talent/model surname (block capital letters) ______________________________
Talent/model given name(s) ______________________________
Talent/model stage name(s)/pseudonyms/aliases ______________________________
Street or PO Box__________________________________________
City _______________________
State/province/district _____________
ZIP/postal code _____________
Email: ______________________________________
Cellphone / mobile / landline (optional) _________________________
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