Warsztaty SO 2015 wizerunek

Tarnów, .........................
STATEMENT
I, the undersigned, hereby declare that I shall not claim any financial benefits in connection with *my
or my daughter’s/son’s performance in front of the photo and video camera during the project titled
“International Dance Theaters Festival OPEN STAGE in Tarnów”.
Hereby, I assign the rights to the artistic performance and the use of my image and voice recorded on
photo and video material to Centrum Sztuki Mościce of Tarnów, 33-101 Tarnów, ul. Traugutta. The
above acquisition shall take place without any temporal and territorial restrictions, without the
necessity of paying any additional fees. Acquisition of rights shall apply to all existing fields of
exploitation of an audiovisual work.
In particular, I hereby assign, on an exclusive basis, all property rights to the work to Centrum Sztuki
Mościce of Tarnów on the following fields of use:
a. public performance or public playback, without limitations;
b. recording and multiplication with the use of analogous and digital technique, on all carriers
(including video tape), as well as marketing;
c. entering into computer memory, entering into a network and exploitation within IT networks
(including Internet and Internet2);
d. performance, playback, staging, screening, lease, tenancy or marketing;
e. screening in cinemas;
f. broadcasting with the use of wired or wireless video and audio, or video or audio, by a
terrestrial station, broadcasting via a satellite, simultaneous integral broadcast of the work
being broadcast by another radio or television organisation, and retransmission;
g. preparing foreign language versions;
h. all property rights to the work with respect to recording and multiplication with the use of
printing or typographic techniques, as well as marketing (including press releases,
announcements, brochures, posters, billboards and other).
.....................................................................................
/legible signature of a parent or a major/
*delete as appropriate