2-5-1 - Guest Agreement & Release

• The guest does hereby consent to the recording and distribution of reproduction(s) of the Guest's voice and performance as part of the media program entitled “2-5-1” (herein referred to as the "Program"). This is to confirm that the undersigned has agreed to be interviewed or otherwise participate in the Program, a production of the “2-5-1”.
• As a condition of publication/broadcast and for no monetary compensation, “2-5-1” requests the non-exclusive worldwide rights to reproduce, distribute, and sell your oral and/or video presentation, in whole or in part, in any media, as part of this Program published under the auspices of “2-5-1” and to license these rights to others, in perpetuity. “2-5-1” shall have the right to edit and/or transcribe your presentation.
• You also grant “2-5-1” the right to use your name, biography and likeness in connection with the Program.
• You warrant that your presentation is original with you, that publication/broadcast will not infringe on the rights of others, and that you have full power to grant this license. Should your presentation/broadcast incorporate copyrighted materials of others, you warrant that you have obtained such permission from those parties for publication/broadcast by “2-5-1”, consistent with this Agreement.
• If the foregoing terms are satisfactory, please sign and date this agreement below and return it to the Program coordinator. Execution of this Agreement does not obligate “2-5-1” to publish your presentation or other materials.
• I hereby consent to the use of my oral and/or video presentation as described and agree with the provisions of this release form.