PACCAR Talent Release Form

First Name *

Last Name *

Email Address

Description of Photography/Video *

Address *

Street address *

City *

State *

Postcode *

Job or Reference *

Date of Photography/Video: *

I permit the organisation named above and his licensees or assignees to use the photograph(s) and the video footage and any other reproductions or adaptations there from, either complete or in part, alone or in conjunction with any wording and/or drawings for all uses including publicity and/or merchandising and/or editorial purposes and/or advertising in any country and in any media (applicable to both a person and objects used in the video or photographs, e.g. a truck).

Unless otherwise agreed the photograph(s), the video footage and any drawings or adaptations thereof shall be deemed to represent an imaginary person.

I understand that I do not have any interest in the copyright of the photograph(s) and the video footage nor shall I receive any payment.

• I am over 18 years of age

Signature of Participant *

Clear

Name of witness