(1)    I agree to your recording my likeness and/or voice on film and/or tape, and to edit such film and/or tape at your discretion in connection with the telecasting and my participation on your television program entitled                                                                                                                     herein referred to as "The Program".

(2)    I acknowledge that you are and will be the sole owner of all rights in and to The Program and any recording, filming or taping thereof for all purposes.  You shall have the right and authority to reproduce, publish, broadcast and use The Program in any manner, media or form whatsoever, including unrestricted use for the purpose of publicity, advertising and sales promotion, and to use my likeness, voice and biographical and other information concerning my appearance on and participation in The Program.

(3)    I understand I shall receive no compensation for any appearance on or participation in The Program.

(4)    I agree to indemnify and hold you and any third parties harmless from any and all liability, loss or damages (including reasonable attorneys fees) caused by or arising in any manner from my appearance on The Program including any utterance made by me on The Program or material furnished by me in connection with my participation on The Program.


Signature of participant                                                                                                         



Accepted by: