Publicity Rights Claim Form

Publicity Rights Claim Form
Submit your claim regarding the use of your name, image, likeness, or other personal attributes.
Claimant's Full Name
First NameLast Name
Claimant's Email Address
example@example.com
Claimant's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Claimant's Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Are you the subject whose publicity rights are involved?
Name of the Subject (if different from claimant)
First NameLast Name
Relationship to the Subject (if applicable)
Describe the publicity rights being claimed (e.g., name, image, likeness, voice, signature, etc.)
Please describe the incident or context in which your publicity rights were used or infringed.
Date of Incident (if applicable)
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Location of Incident (if applicable)
Please upload any supporting documentation (e.g., screenshots, correspondence, contracts)
Cancelof
What action or resolution are you seeking?
Signature of Claimant or Authorized Representative
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