APPEARANCE RELEASE

I, the undersigned, hereby give permission to Indiana University and Indiana University-Purdue University at Indianapolis to videotape my voice, name, physical likeness, and appearance in connection with a production entitled and described as follows:

I hereby assign and license to the Trustees of Indiana University (“IU”) any and all copyright or other literary rights that I may have in and to said production. I will receive no remuneration for my participation in this production.

I hereby agree that IU and its assigns, agents, employees, licensors, and successors (collectively the “IU parties”) may, by any media whatsoever, produce, distribute, exhibit, broadcast, and promote scenes of me in connection with said production, and may sell or license the same for distribution, exhibition, or broadcast to any other person or entity and that the IU parties may make reference to and use my name, voice, and likeness. I further agree that the IU parties may edit scenes and my appearance in the production, and may use or authorize others to use such scenes in other formats. I waive all personal or proprietary rights with respect to the production.

Signed: ______________________________ Date: ______________________

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