By submitting this form and other required materials, you have read and fully understand all of the information. You agree that all information supplied by you is accurate and correct and you accept any legal obligations that may occur for any false information and/or documents.

Photo/Video/Music Release Form (please print)

Name(s) _________________________________________________________

________________________________________________________________

_________________________________________________# of Members____

Group/stage name _____________________________Genre _______________

Address _________________________________________________________

City State Zip _____________________________________________________

Phone # ( ____ ) ____________________ Alt # (______) ___________________

As acknowledgment of my receipt of sufficient consideration, I hereby give the following authorization and permission to Motion Video Productions, Tuscaloosa, Alabama, permission to publish, republish, copy and/or exhibit any or all photographs, videos, music, etc. in print, broadcast television, or on the World Wide Web.

I understand that I am to receive no compensation for my appearance in such photographs, videos, telecast, etc. Further, I understand that I am to receive no compensation of any kind as a result of any use by Motion Video Productions, thereof. Permission to use my name in connection with photographs, videos, music, etc. is also granted, by me, and I release Motion Video Productions, its offices, employees, agents, and designees from any and all liability, including personal or proprietary rights that I have in connection with such use. Any and all photographs, videos, music, etc. submitted by me remain solely with Motion Video Productions.

Name _________________________________________ Date _____________

Signature _________________________________Position_________________

E-mail address ____________________________________________________