1. I the undersigned, agree to be filmed/interviewed/photographed for jtvcancersupport.com. I hereby give my consent to Mosaic North Ltd (the Company) facilitating the jtvcancersupport.com project to use the films, photographs and sound recordings made by the Company for the Film in which I feature, or any literary, dramatic, musical or artistic work or film or sound recording created by me or any performance by me of any literary, dramatic, musical or artistic work or film or sound recording included by the Company in the Film in any and all media by any and all means now known or invented in future throughout the world for the full period of copyright, including all renewals, revivals, reversions and extensions.
2. No payment of any kind will be given in exchange for taking part in this project.
3. I irrevocably and unconditionally grant to you all consents required pursuant to the Copyright, Designs, and Patents Act 1988 Part II * or otherwise under the laws in force in any part of the world to exploit such performances.
4. I irrevocably and unconditionally waive all rights which I may have in respect of the Film pursuant to the Copyright, Designs and Patents Act 1988 Sections 77, 80, 84 and 85**.
5. I consent to the use by the Company of my name, likeness, voice and biography in connection only with the Film, unless specifically stated.
6. The Company may assign or license this agreement to any third party.
7. This letter shall be governed by and construed in accordance with the law of England and Wales and subject to the jurisdiction of the English Courts.

*the “Performers Rights.
** the Moral Rights of an author.

508-510 Manchester Road, Stocksbridge, Sheffield, S36 2DU, United Kingdom
Phone: 0114 288 4091 Mob: 07971 595 648 Vat No. 923 3665 23 Company No. 6434055