Citizens' Network Project

Video Release Form


The ______________________________________________________ grants Washington State Department of Information Services permission to sublicense, royalty-free, the Video Program entitled,

_______________________________________________________________ for the limited purpose of the Citizens' Network Project. The Citizens' Network Project makes video programs available to ‘Access’ broadcast/cablecast organizations for broadcasting. Video programs will be used in their entirety and will not be used for commercial purposes.

This sublicense agreement will be in effect until ____________ or until revoked upon reasonable notice.

Agreed:

_________________________________
Signature

_________________________________
Printed Name

_________________________________
Title

_________________________________
Date


Fax or mail this form to:
Shawndra Michell
DIS-IT Citizens' Network
P O Box 42445
Olympia, WA 98504-2445
Tel# 360-407-0550
Fax# 360-438-7996