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California nt and Release on this _________________. Subject (Signature) (Name, please print) (Address) AGREED: Producer Depiction Release (Grant with Reversion, Consent and Release) 3 g the release, which if known by him or her must have materially affected his or her settlement with the debtor." In witness hereof and in full understanding of the foregoing, I have signed this Conseral release does not extend to claims which the creditor does not know or suspect to exist in his or her favor at the time of Depiction Release (Grant with Reversion, Consent and Release) 2 executin are fully signed and performed within the State of California and I hereby waive any rights I may have, known or unknown, pursuant to Section 1542 of the California Civil Code which provides: "A gened to me that I consult with my attorney concerning this Consent and Release. This Consent and Release shall be construed according to the laws of the State of California applicable to agreements whichpon me and my heirs, executors, administrators and successors. I acknowledge that you have explained to me that this Consent and Release has been prepared by your attorney and that you have recommendehat you are under no obligation to exercise any of the Granted Rights and agree I have not received any promises or inducements other than as herein set forth. The provisions hereof shall be binding unot been induced to do so by any representations or assurances, whether written or oral, by you or your representatives concerning the manner in which the Granted Rights may be exercised and I agree tal understandings have been made with regard thereto. This Consent and Release may be amended only by written instrument signed by you and me. I acknowledge that in granting the Granted Rights I have dialogue which may be in the public domain from whatever source derived. 8. ENTIRE UNDERSTANDING: This Consent and Release expresses the entire understanding between you and me, and I agree that no orstrued 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 d, it being my understanding that my sole remedy shall be the right to recover damages with respect to any such breach. 7. PUBLIC DOMAIN MATERIAL: Nothing in this Consent and Release shall ever be cone right, in the event of any such breach, to equitable relief or to enjoin, restrain or interfere with the production, distribution, exploitation, exhibition or use of any of the Granted Rights grante power coupled with an interest and are irrevocable. 6. REMEDIES: No breach of this Consent and Release shall entitle me to terminate or rescind the rights granted to you herein, and I hereby waive thte any such documents and instruments, if said documents and instruments shall not be inconsistent with the terms and conditions of this Consent and Release. Your rights under this clause constitute ae terms and intentions of this Consent and Release, and in the event I fail or am unable to execute any such documents or instruments, I hereby appoint you as my irrevocable attorney-in- fact to execu arising out of the so-called right of privacy and/or right of publicity. 5. FURTHER DOCUMENTS: I agree to execute such further documents and instruments as you may reasonably request to effectuate th 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 claime use thereof. 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 willion, Consent and Release) 1 infringement of copyright or violation of any other right arising out of or relating to any utilization of the Granted Rights or based upon any failure or omission to maks from any and all claims, demands or causes of actions that I may now have or may hereafter have for libel, defamation, invasion of privacy or right of publicity, Depiction Release (Grant with Reverseement was executed, all rights granted by me under this agreement shall be perpetual. 3. RELEASE: I agree hereby to release and discharge you, your employees, agents, licensees, successors and assignthe date this agreement was executed, all rights granted by me under this agreement shall revert to me. I understand that if you do begin production within _________________ years of the date this agrmentioned in paragraph 1 only if you begin production of a feature film or television movie or television pilot. In the event that you do not begin such a production within _________________ years of to any matter referred to herein. Any and all of the Granted Rights shall be freely assignable by you. 2. PAYMENT OF CONSIDERATION; REVERSION OF RIGHTS: I understand that you shall make the payments on, simulation and/or imitation or other modification as you, your successors and assigns, determine in your sole discretion. I further acknowledge that I am to receive no further payment with respectrther understood and agreed that the Granted Rights may be used in any manner and by any means, whether now known or unknown, and either factually or with such fictionalization, portrayal, impersonatiall media of every nature whatsoever, whether now known or hereafter devised. I reserve no rights with respect to such uses. (All said rights are hereinafter referred to as "Granted Rights"). It is fu and agreed that said exclusive right includes theatrical, television, dramatic stage, radio, sound recording, music, publishing, commercial tie-up, merchandising, advertising and publicity rights in ith motion pictures, sound recordings, publications and any other media of any nature at all, whether now known or hereafter devised. Without limiting the generality of the foregoing, it is understoodation and personal experiences, incidents, situations and events which heretofore occurred or hereafter occur (in whole or in part) based upon or taken from my life or otherwise in and in connection wledge I hereby grant you, perpetually and irrevocably, the unconditional and exclusive right throughout the world to use, simulate and portray my name, likeness, voice, personality, personal identificvie, and/or $_________________ upon the beginning of production of a pilot program and a royalty of $_________________ for each episode thereafter, and for other valuable consideration, with full knowayment to me of $_________________ upon the beginning of principal photography of a full-length Theatrical Motion Picture, and/or $_________________ upon the beginning of production of a television mod to grant you certain rights in that connection. This Consent and Release confirms our agreement as follows: 1. CONSIDERATION; GRANT OF RIGHTS: In consideration of your efforts to produce my story, p 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 agree____________ (Producer) 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 andbe consulted before negotiating any document with another party. The purchase and use of this form is subject to the "Terms and Conditions" found at www.FindLegalForms.com DEPICTION RELEASE To: _____s form is not intended and is not a substitute for legal advice. This form should only be a starting point for you and should not be used without first consulting with an attorney. An attorney should Information Depiction Release (Grant with Reversion, Consent and Release) Bracketed instructions may be included on this form to assist you in completing it and should be removed before printing. Thi California