CONTRIBUTORS RELEASE FORM

pRoJECrrrrr-r ffiaiin*e fln,io jhur,t ("the Project")

DESCRIPTION OF CONTRIBUTION

/Trr.l el

DATE OF FILMING/CONTRIBUTION

tt /o,l r\NAME OF PRODUCTION COMPANY/ORGANISATION RUNNING THE PROJECT

figqtL P*rtq. fK^,*lrs -flhrru; -(,,the company,,)

TELEPHONE NUMBER OF CONTRIBUTOR

(t41o9 110 spz

ln consideration of the Comp-any agreeing that I contribute to and participate in the project,the nature and the content of which has been fully explained to me, t heieby consent to thefilming and recording of my contribution to and participation in the project slnject to theterms and conditions specified below.

Signed by Contributor

NAME OF CONTRIBUTOR

ADDRESS OF CONTRIBUTOR