CONTRIBUTORS RELEASE FORM

pRoJECr 'r,'rr. YU4, d * Al*t ("the project")

DESCRIPTION OF CONTRIBUTION

f+rt€fDATE OF FILMING/CONTRIBUTION

.,,. i r _'

NAME OF PRODUCTION COMPANY/ORGANISATION RUNNING THE PROJECT

("the Company")

ADDRESS OF CONTRIBUTOR

12 f-d,h *^r/

TELEPHONE NUMBER OF CONTRIBUTOR

07 K+61s3 I Z6

ln consideration of the Company agreeing that I contribute to and participate in the Project,the nature and the content of which has been fully explained to me, I hereby consent to thefilming and recording of my contribution to and participation in the Project subject to theterms and conditions specified below.

NAME OF CONTRIBUTOR