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I understand that you desire to use all or parts of the events of my life in order to have
one or more teleplays or screenplays written, and to produce, distribute, exhibit and
exploit one or more television programs and/or motion pictures of any length in any
media now known or hereafter devised and sound recordings in any media now known or
hereafter devised. I have agreed to grant you certain rights in that connection. This
Consent and Release confirms our agreement as follows:
4. NAME - PSEUDONYM: You have informed me and I agree that in exercising the
Granted Rights, you, if you so elect, may refrain from using my real name and may use a
pseudonym which will be dissimilar to my real name, however, such agreement does not
preclude you from the use of my real name should you in your sole discretion elect and
that in connection with it I shall have no claim arising out of the so-called right of privacy
and/or right of publicity.
7. PUBLIC DOMAIN MATERIAL: Nothing in this Consent and Release shall ever be
construed to restrict, diminish or impair the rights of either you or me to use freely, in any
work or media, any story, idea, pilot, theme, sequence, scene, episode, incident, name,
characterization or dialogue which may be in the public domain from whatever source
derived.
"A general release does not extend to claims which the creditor does not
know or suspect to exist in his favor at the time of executing the release,
which if known by him must have materially affected his settlement with
the debtor."
In witness hereof and in full understanding of the foregoing, I have signed this Consent
and Release on this XXXXXXXXXXX.
______________________
(Signature)
______________________
(Name, please print)
______________________
(Address)
AGREED:
______________________
by:____________________
XXXXXXXXXXXXX (Production Company)