I hereby consent to and authorise the above named to reproduce, copy, exhibit, broadcast, screen and distribute in any manner it deems appropriate, throughout the world, my participation in video footage for the above named to include video and/or audio recordings of me.

I understand that my participation will be edited and there is no guarantee that my participation will appear in the final production. I have agreed to waive all fees for the use of my participation.

I understand that Glass Eye Productions, of Marshes Street, Thomastown, Co Kilkenny as producers of this material owns all copyright to these materials. However, this material will strictly only be used as instructed by and agreed with the above named.

The media from this production may be distributed in many digital formats, including DVD, Social Media, Internet, presentation, work-shop and conference materials, solely for the purposes of the above named.

I release Glass Eye Productions and the above named from all claims of any nature whatsoever which may arise in the connection with these materials.