Media ReleaseI authorize Plum Media (Producer) to make use of my appearance, including my name, voice, likeness and biographical information in the television program titled JOHN MCGIVERN’S MAIN STREETS (Production) being produced initially for Plum Media. I understand that I am to receive no compensation for this appearance, andthat I am to receive no compensation of any kind as a result of any recordings, rebroadcasts, or other broadcast or non-broadcast uses of the Production. My work in the Production shall be a work made for hire for Producer under the copyright laws of the United States of America. Producer shall have complete ownership of the Production, including full domestic and foreign copyright, and shall have the exclusive right and license to make such use of the Production as it wishes, including (but not limited to) the right of performance, display, reproduction, and distribution in all media in any form, and the right to create, perform, display, and distribute derivative works of the Production in any form. I further give the Producer the right to use my name, likeness, and biographical material to publicize the Production, derivative works of the Production, and the services of the Producer. I understand that this agreement has no end date or limit as to number of times that the Producer can utilize my appearance in this or derivative productions. Episode NameSELECT ONEHollandAmana ColoniesWoodstockFort WayneWinonaEscanabaMenomonee ValleyIowa CityGoshenDodgevilleLincoln SquareDe PereBloomingtonSELECT ONEShoot DatePlum ProducerSelect OneLoisEmilyEvanLanceKenInternOtherNameName as you wish to appearTitleStreet AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeEmail AddressPicture UploadChoose FileNo file chosenDelete uploaded fileSignatureStart signing your signature hereYour browser does not support e-Signature field.Submit