Appearance Release Form

OMB Control No. 0690-0030

Expiration Date: 04/30/2014

APPEARANCE RELEASE

I authorize the National Oceanic and Atmospheric Administration and their agents, assigns and benefactors to record my appearance in a video piece for focus group research.

I agree that you may videotape, photograph me, and/ot record my voice, conversation and sounds during and in connection with my appearance and that you shall be the exclusive owner of the results and proceeds of such taping, photography and recording with the right, forever and throughout the world, to use for research purposes. This footage will not be re-purposed in any way other than to obtain survey results of the focus group.

Name:
Signature:
Date:
Address:
Phone:

If subject is under 18, signature of legal parent/guardian is required.

Parent / Legal Guardian Name:
Signature: Date:
Address:
Phone:

This information collection contains requirements subject to the Paperwork Reduction Act (PRA).  Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subject to penalty for failure to comply with, a collection of information subject to the requirements of the PRA, unless that collection of information displays a currently valid OMB Control Number.  The estimated response time for this collection is two hours.  The response time includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.