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Talent Release Form

"*" indicates required fields

Step 1 of 3 – Program Info

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Program Title*

Member Producer Name*

First Last

Producer Email*

Production Location*

Production Date*

MM slash DD slash YYYY

Talent Name*

First Last

Talent Address

Street Address Address Line 2 City State ZIP Code

Talent Email

Talent Phone*

Consent*

I hereby assign all rights and release from liability the producer(s) and 1623 Studios (Cape
Ann Regional Cable Television Access Corporation) for the recording, reproduction, exhibition, telecasting, webcasting, and distribution of my visual image and voice.

I hereby consent that any content, which has been or is about to be made by the above
producer(s) may be used for the purposes explained

I have read and agree to this consent

Signature*

Name

This field is for validation purposes and should be left unchanged.

Cape Ann’s Community Media Center

11 Pleasant Street, Gloucester, MA 01930 • 978.281.2443

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