RELEASE FORM

Date: _______________________________________________________

Writer's Name: _________________________________________________

Title: _________________________________________________________

Registration/copyright # is applicable: ________________________

Principal Characters: __________________________________________

Brief Summary of Plot:(Logline) ________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

I am today submitting my script herein identified as "Material: to you for your review and critic only. I acknowledge that the Material was created and written by me without any suggestion or request from you. I warrant that I am the sole owner and author of the above titled Material and that I have the full right and authorization to submit the Material to you.

I agree that any part of the Material which is not novel or original and not legally protected may be used by you without any liability on your part to me and that nothing herein shall place you in any different position with respect to such non-novel or non-original Material by reason herein.

You shall not be under any obligation to me with respect to the submitted Material except as may later be set forth in a full executed written agreement between us.

I realize that you may have had access to and/or may have independently created or have had created ideas, themes, formats and/or other materials which may be similar to the theme, plot, idea, format or other element of the Material now being submitted to you by me and I agree that I will not be entitled to any compensation by reason of the use by you of such similar material.

I have retained a copy of the said Material and I release you from any liabiliy for loss or other damage to the copy or copies submitted to you. I hereby further state that I have read and understand this agreement; that no oral representations of any kind have been made to me; that there are no prior or contemporaneous or oral agreements in effect between us pertaining to said Material; and that this agreement states our entire understanding.

I further submit that I am of legal age, being over eighteen (18)years of age, and my signature upon this Release Form is thereby binding and legal.

Sincerely,

Signature: _____________________________________________________

Print Name: ____________________________________________________

Street Address: ________________________________________________

Town/City: _____________________________________________________

State: _________________________________________________________

Postal/Zip Code: _______________________________________________

Country: _______________________________________________________

Telephone: _____________________________________________________

Fax: ___________________________________________________________

Email Address: _________________________________________________