Milton Ulladulla Videography Club Inc
Tony Mann Secretary
24 Coral Tree Lane
LITTLE FOREST NSW 2538 Phone: (02) 4456 5050
Mobile: 0409 592 189
Email: tonymann@outlook.com.au
CONSENT TO BE VIDEO RECORDED and/or AUDIO RECORDED
This is to certify that I :
NAME :
PLEASE PRINT
ADRESS:
PLEASE PRINT
PHONE:
EMAIL:
Hereby give permission to the members of Milton Ulladulla Videography Club Inc to video record images and
related audio of me, within their video production of:
I grant the Milton Ulladulla Videography Club Inc the right to make a visual recording and/or audio recording of my participation within the
above named production and authorise the use of the recording in whole or part in any manner the Milton Ulladulla Videography Club Inc
considers appropriate, including for promotional purposes, editing, synchronisation with visual images, adaptation for other publications (written
or electronic) and re-publication.
I herby give permission that my visual recording and/or audio recording of my participation may be used and shown within
Contests and/or Film Festivals for public viewing within Australia.
Including the Reel Escape Film Festival at Milton Theatre
I agree to grant the Milton Ulladulla Videography Club Inc the above with no fee.
SIGNED:
As named above
SIGNED:
For and on behalf of Milton Ulladulla Videography Club Inc
DATE:
DATE:
http://www.muvc.club