Stage Appearance Release Form

All performers, musicians, and dancers who will be on stage must complete the following online form or download the hard copy and either mail in or bring in the Stage Release Form.
Download Hard Copy Stage Release Form. Mailing Address, P.O. Box 588, Indiantown, FL 34956. For questions call (772) 985-9121

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Project Title: Hannaian.com Treasure Coast Blues Festival & Shuffle Boogie Dance Extravaganza

In consideration for value received and any other good and valuable considerations, receipt of which is hereby acknowledged, I, being of legal age, hereby give The Hannaian Entertainment Company, their licensees, successors, legal representatives, and assigns the absolute and irrevocable right and permission to use my name and to use, reproduce, edit, exhibit, project, display, copyright, publish and/or resell photography images and/or moving pictures and/or videotaped images of me with or without my voice, or in which I may be included in whole or in part, photographed, taped, videotaped, and/or recorded at the Hannaian Treasure Coast Blues Festival November 6, 2010 and thereafter, and to circulate the same in all forms and media for art, advertising, trade, competition of every description and/or any other lawful purpose whatsoever. I also consent to the use of any printed matter in conjunction therewith.

I hereby waive any right that I may have to inspect and/or approve the finished product or products or the editorial, advertising, or printed copy or soundtrack that may be used in connection therewith and any right that I may have to control the use to which said product, products, copy and/or soundtrack may be applied.

I hereby release, discharge and agree to save The Hannaian Entertainment Company, their licensees, successors, legal representatives and assigns from any liability by virtue of any blurring, distortion, alteration, optical illusion or use in composite form whether intentional or otherwise that may occur or be produced in the making, processing, duplication, projecting or displaying of said picture or images, and from liability for violation of any personal or proprietary right that I may have in conjunction with said pictures or images and with the use thereof.

Registration Category

Date this form is being filed (e.g., January 1, 1998)

** (required)

Full name of person submitting this Registration (e.g John A. Smith)

**

Business or Company name if any:

Registrant's First Name:

**

Registrant's Last Name:

**

Middle Initial:

Email Address:

**

Internet Website Address

Street Address:

**

Additional Address:

City:

**

State:

Zip/Mailing Code (use12345 If no mail code):

**

Country:

Home Telephone #:

( )

Business Telephone #:

( )

Fax Number:

( )

Gender:

Male Female

Age:

Describe details of your Stage Appearance:

Please type in your name & position submitting your signature in agreement with the provisons of this Stage Appearance Release.
Thank You


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