PRODUCTION TITLE:
PRODUCER:
DIRECTOR:

MUSICIAN RELEASE FORM

To Whom It May Concern:

For valuable consideration, the receipt of which is hereby acknowledged, I (the undersigned) do hereby give
the _________________________ (hereinafter sometimes referred to as “you”) permission to reproduce
and record and make duplicate copies of such recordings of any and all musical compositions performed,
composed, arranged, or conducted by me in synchronism or timed relation to the motion picture entitled
and I do hereby grant to you, your successors, assigns and licensees the perpetual right to use, as you may
desire, all soundtrack recordings and records which you may make of my musical performance in or in
connection with the exhibition, advertising, exploitation, or any use of such motion picture or recording.

Signature:

Name (Please Print):

Home Address:

Telephone:

Date:

Working in the capacity of (tick appropriate title):
COMPOSER
ARRANGER
CONDUCTOR
PERFORMER