I, the individual completing this form (“ARTIST”), do hereby agree to allow Dave Fairman and/or Light in the Attic Films (“FILMMAKERS”) to use my original piece of music (“WORK”) in the production entitled DEBT (“FILM”).

I own the sole and legal copyright to the described WORK, and hereby agree to the use of this work in FILM, as well in promotion, production and distribution of the FILM without further compensation. I understand also that any and all proceeds from the film are the property of the FILMMAKERS.

I understand that FILM and related promotional materials may be distributed in any manner deemed appropriate by the FiLMMAKERS, which may include but not be limited to theatrical distribution, online digital distribution, film festival screenings, and/or private screenings.

ARTIST's name and likeness may be used in advertising and promotional material for the FILM, but not as an endorsement of any product or service.

ARTIST hereby releases and discharges FILMMAKERS from any and all liability arising out of or in connection with the making, producing, reproducing, processing, exhibiting, distributing, publishing, transmitting by any means or otherwise using the WORK as described.

All rights in and to ARTIST's original WORK shall remain the sole property of the ARTIST and the rights granted herein are for use in association with FILM only. This release does not include any rights to mechanical reproduction of the music in regards to phono records, compact discs or any other form of reproduction that may now exist or may come into being.

I am 18 years or over.

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