Model Release Form

Full Name:

Address:

Telephone Number:

Shoot Location: Arts Centre, Darlington

Date: Wednesday 8^th January, 2012.

I hereby give Margaret Newlands , the irrevocable and unrestricted right to use and publish video footage or photographs of me that are taken on the above date. These may be used for educational purposes (that may include publishing to a public video forum, such as Youtube or a blog), film production or advertising.

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