Entertainment Industry Publicity Consent Form
Please complete this form to provide your consent for publicity and media use related to the specified entertainment project.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Project or Production Name
*
Type of Media/Publicity Release
*
Photographs
Video Recordings
Audio Recordings
Interviews
Other
Scope of Permitted Use
*
Please Select
Any media worldwide, in perpetuity
Specific campaign or event only
Online media only
Broadcast media only
Other
Compensation or Consideration (if applicable)
Signature
*
Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Consent
Submit Consent
Should be Empty: