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By signing this form, I give consent to the Corporation and ________________________ to record, use and reproduce my name, likeness, voice, and statements made by me on video-tape, film or otherwise for use in the above production, or parts thereof. I agree that the production may be edited as desired and used in whole or in part for any and all broadcasting audio-visual, and/or exhibition purposes in any manner or media, in perpetuity, throughout the world. I understand that I have no rights to the production or any benefits there from.