Name of Short Film ("Ascension") ……………………………………………………………….
Name of Production Company/Organiser (“Rolling”)
………………………………………………………………………………………………………
Description of Involvement ……………………………………………………………………
……………………………………………………………………………………………………….
Date of Filming ................................................................................................................
Name of Contributor ……………………………………………………………………………
Address of Contributor …………………………………………………………………………
……………………………………………………………………………………………………….
Contact Number of Contributor ………………………………………………………………
In consideration of the Organiser agreeing that I contribute to and/or participate in the Film, the nature and the content of which has been fully explained to me, I consent to the filming and recording of my contribution to and/or participation in the Film subject to the terms and conditions specified below.
Signed by Contributor …………………………………………………………………………..
Dated………………………………………………………………………………………………..
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