CONTACT INFO AND RELEASE FORM Name: Surname: _

CONTACT INFO AND RELEASE FORM Name: _______________________________________________ Surname: ____________________________________________ Preferred position (s): ___________________________________________________________ Spoken languages: _______________________________________________________________ Fields of interest / expertise: ___________________________________________________ _____________________________________________________________________________________ E-­‐mail: ______________________________________________ Phone number: ____________________________________ I am informed that casting is being video recorded and broadcasted. I hereby agree that the copyright and all other rights in respect of my performance are hereby assigned to KEA (Københavns Erhvervsakademi) I agree that the footage I have contributed to may be exhibited in all media and formats. This may include, amongst others, public screenings and broadcast screenings. KEA may use, from the footage in which I am filmed -­‐ referred to herein -­‐ my name, likeness, biography, photographs of me and recordings of interviews with me in publicising the footage from this production and other KEA productions in all media and formats. I hereby agree that my performance in this footage is not for any payment or deferred payment. Signature: ___________________________ Date: ________________________