Appearance Release Form
Isa “GlitterGirl” Isaacs/Temple of Poi, 953 Mission St., Ste. 11, SF, CA, 94103
I authorize Isa “GlitterGirl” Isaacs/Temple of Poi/PoiGeek (“the Producers”) to make use of my
appearance for the Temple of PoiGeek 2008 Fire Dancing Expo (“the Program”) held in Union Square,
San Francisco, April 26 2008.
For valuable consideration, receipt of which is hereby acknowledged:
I agree that the Producers may tape and photograph me, and record my voice, conversations and sounds,
including any performance of any fire dancing composition(s), during and in connection with my
appearance and that the producers shall be the exclusive owner of the results of such taping,
photography and recording with the right throughout the world, an unlimited number of times in
perpetuity, to copyright, to use and to license other’s to use, in any manner that does not directly charge
money, all or any portion thereof or of a reproduction thereof in connection with the Program or
I further agree that the Producers may use and license others to use my name, voice, likeness and any
biographical material concerning me which I may provide, in any and all media and in the promotion,
advertising, publicizing of the Program and/or otherwise throughout the world, in all media, an
unlimited number of times in perpetuity and that I shall not be entitled to any compensation in
connection with said use. Without in any way limiting the foregoing, I acknowledge that the Producers
have the right to edit my performance in connection with its exercise of said rights.
I also understand a copy of my appearance will be made available to me upon when I request it within
30 days of my appearance at a rate of $50 per 5 minutes of footage ($10 per minute thereafter) in a
format mutually agreed to between The Producers and me.
I further represent that any statements made by me during my appearance are true, to the best of my
knowledge, and that neither they nor my appearance will violate or infringe upon the rights of any third
I hereby waive any right of inspection or approval of my appearance or the uses to which such
appearance may be put, understanding and agreeing that The Producers agree to use said appearance in a
way that will positively represent me, the art form and The Program. I acknowledge that you will rely on
this permission potentially, at substantial cost to you and hereby agree not to assert any claim of any
nature whatsoever against anyone relating to the exercise of the permissions granted hereunder.
Name: ____________________________________ __________
Phone #: ________________________________Email:______________________________________