Contributor release form

Date:

Name: (PRINT)

Age:

Gender:

Address:

Mobile Number:

Advert Title:

Contribution to the advert:

In consideration of the above advert production, agreeing that I contribute to and

participate in the above advert production, the nature of which has been fully
explained to me, I hereby consent to the use of my contribution in the above
programme. I agree that the copyright of this contribution shall be wholly vested in
the advert.
.(Signature of participant)

(For advert producer)

I agree I have seen and agreed with all the above information.
.(Signature of producer)