Celebrity Interview Footage Usage Consent
Grant permission for the use of your interview footage for media, promotional, or other agreed purposes.
Celebrity Full Name
*
First Name
Last Name
Are you the celebrity or an authorized representative?
*
Celebrity
Authorized Representative
If you are a representative, please provide your full name
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Name of Interviewer or Production Company
*
Date of Interview
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Purpose(s) for which the footage may be used
*
Broadcast (TV, Radio, Online)
Promotional Materials
Social Media
Archival/Documentary Use
Other
Please specify any restrictions or special conditions for usage
Signature
*
Submit Consent
Submit Consent
Should be Empty: