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Media Broadcasting Release Form
By the Copyright Holder

I, the undersigned, do hereby grant to TEXAS BROADCASTING NETWORK, its employees or
agents, and any associated domain names, web sites, or broadcasting stations the perpetual right
to broadcast audio and/or video recordings of me/and or my musical group, or to make
available to the public any audio or video recordings of me beginning on today’s date and to use
these in any and all media, now or hereafter known, and exclusively for the purposes of
TEXAS BROADCASTING NETWORK.
This release may be cancelled by 30-days written notice by either party.

These recordings may include interviews, performances, or recordings that I have made in the past
or will make in the future. I further consent that my name and identity may be revealed therein
or by descriptive text or commentary. These recordings may be broadcast on the Internet, cable TV,
TV, radio, podcasts, in live feeds to other broadcasters or any other media deemed appropriate
by TEXAS BROADCASTING NETWORK. The actual playing time may also be reported
to ASCAP, BMI, Sound Exchange and other licensing or reporting agencies.

I hereby release to TEXAS BROADCASTING NETWORK, its agents, and employees and assigns,
all rights to exhibit my work in part or in the whole, publicly or privately or in conjunction with other
artists and/or musicians of all genres. I waive any rights, claims, or interest I may have
to control the use of my identity or likeness in whatever media used.

I understand that there will be no financial payment for recording me or for playing my recordings,
or for granting interviews, either for initial or subsequent transmission or playback.

I also understand that TEXAS BROADCASTING NETWORK is not responsible for any expense
or liability incurred as a result of my participation in any live recording, including medical expenses
due to any sickness or injury incurred as a result.

I represent that I am at least 18 years of age, have read and understand the foregoing statement.
I am the legal owner of this copyrighted material and have the right to grant license to broadcast such
recordings and am competent and authorized to execute this agreement on behalf of myself
and/or my group(s).

                       Name: ____________________________________           Date _____________
                       Group Name: _____________________________________________________
                       Address: _________________________________________________________
                       Phone: _______________________________

Signature: _________________________________________________

E-mail: ___________________________________________________
Web Site: _________________________________________________

Please print, fill out, sign, and return to:

James Ellis - TBN 1501 Woodlawn Pky Mesquite, TX 75149

If you have audio or video CD's or DVD's that you wish for us to consider broadcasting,
or if you have recordings of your previous concerts that you would like for us to consider
broadcasting, please include them along with this authorization.

If you would be available for an interview by phone or in person,
please let us know in a separate note.