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MUSIC VIDEO SUBMISSION FORM

ATTENTION: THIS FORM MUST BE FILLED OUT COMPLETELY FOR


VIDEO TO BE OFFICIALLY SUBMITTED!
ARTIST(S):

SONG TITLE:
ALBUM:___________________________________________________________________________________

RECORD LABEL(S):

VIDEO DIRECTOR: ________________________________________________________________________

LENGTH OF VIDEO:

CONTACT PERSON:

PHONE NUMBER: E-MAIL:

THE INFORMATION BELOW IS REQUIRED. PLEASE LIST EACH SONGWRITER’S


INFORMATION IN THE ORDER PRESENTED:

EXAMPLE: SONGWRITERS PUBLISHING COMPANY PERFORMING RIGHTS SOCIETY


Jill Scott Blues Baby Music ASCAP
Vidal Davis Touched By Jazz Music, Inc. ASCAP

SONGWRITER(S) NAME: PUBLISHING COMPANY(S) PERFORMING RIGHTS SOCIETY

MAIL THE FOLLOWING:


(1) VIDEO
(2) SUBMISSION FORM
(3) AFFIDAVIT

TO: ERIC RHETT


555 W57TH STREET, 17TH FLOOR
NEW YORK, NY 10019
Attn: BET ON BLAST
RE: Ya Heard? Music Videos
Music Video Submission
Affidavit, Liability & Publicity Release

I __________________________, desire to voluntarily submit my video to BET.com’s “Ya Heard Live


Music Video Performance” (the “Promotion”) and am submitting this affidavit to the BET with the
understanding that it will be relied upon in connection with my participation in the Promotion. For the
purposes of this Affidavit and Liability and Publicity Release, “BET” includes BET Interactive, LLC, its
parent[s], subsidiaries, affiliates, officers, directors, owners and employees, advertising and promotional
agencies, and their respective officers, directors, partners, owners and employees.

1. I hereby affirm that I am legal resident of the State of ___________, United States and am
eighteen (18) years of age or older and not considered a minor in the jurisdiction in which I reside, and
that the Video that I am submitting to BET contains only my image and/or likeness, and my original
sound recording ("Video") and that no other person holds a copyright or any other intellectual property or
other rights in or to the Video. I further certify that the Video may also contain the image and/or likeness
of other people who are all 18 years of age or older. I further certify that if the Video contains images
and/or likeness of other people, I have obtained the consent from all people in the Video to provide the
Video to BET.

2. I understand that my participation in this Promotion is conditioned, in part, upon my agreement to


execute this Affidavit and Liability and Publicity Release. I agree that I will benefit from having my
video transmitted on BET’s website, BET.com, and I hereby acknowledge the sufficiency of this benefit
as consideration for the agreements set forth in this Affidavit.

3. I further agree to the following terms and conditions:

(a) I unconditionally and without any monetary compensation grant to BET, its affiliates, and their
advertising, promotion and production agencies, and their respective assigns, the absolute, royalty
free, irrevocable right to use, or to authorize others to use, my Video, my name (or any fictional name
that I may use in connection with submitting my Video), my image and likeness, and my sound
recording, in or in connection with the Video in any manner or media whatsoever now in existence or
hereafter devised, throughout the world in perpetuity. This grant of right is meant to include, without
limitation, each and every copyright interest necessary for BET’s use of said Video and any sound
recording included therein;

(b) I acknowledge and agree that I shall have no right of approval and no claim arising out the use of my
Video, and I unconditionally waive any right to inspect or approve any works derived from the Video
or any duplication, derivation or digital enhancements thereof or finished version(s) of the foregoing,
including any copies that may be created in connection therewith; and that BET shall have the
unlimited right to vary, change, alter, modify, add to and/or delete images or music contained in the
Video, to rearrange the images contained in the Video, and to use a portion(s) of any image or music
contained in the Video, together with any material of any kind;

(c) I further agree that BET has the sole and absolute discretion to select the Video for use on BET.com
and that the submission of my Video does not constitute any agreement or understanding by
BET.com to select my Video or to display my Video on BET.com

(d) I further agree that BET also reserve the right to refuse to post or to remove any posted Video that in
BET’s sole and absolute discretion contains indecent, obscene, defamatory, unauthorized content, or
is otherwise unacceptable;<p>
4. I represent and warrant that I (or companies which I control) own or control all rights (including
without limitation the copyright rights in the sound recording and underlying musical composition) in and
to the Video I am submitting, and that such Video shall not infringe against the copyright rights or any
rights of any third party. I further represent and warrant that I have the legal capacity under the laws of
the jurisdiction where I reside or from which I am submitting the Video to enter into this Affidavit and
Release and that I possess all rights contained herein necessary for the grant of this Affidavit and Release
and agree to release, indemnify and hold harmless BET, its affiliates, successors, assigns, licensees and
agents from and against any and all claims, damages, liabilities, costs and expenses arising out of a breach
of my representation and warranty.

5. I hereby waive and release, for myself and for my heirs, executors and administrators, any and all
rights, claims and causes of action whatsoever that I may have against BET. I further release, discharge
and agree to hold harmless BET, and its employees, officers and directors, as well as its affiliates,
successors, licensees, assigns and agents and those for whom it is acting, from any claim relating to the
exercise of the rights granted herein and from any liability for any loss or damage I may suffer or any
liability for, including but not limited to, libel, slander, defamation, invasion of any right of privacy or
publicity, or copyright infringement arising out of the use of my Video or any works derived therefrom or
any duplication, derivation or digital enhancements thereof or any reference to me or any other utilization
of the rights granted under this Affidavit and Release.

6. This agreement shall be deemed to be entered into in the District of Columbia, and shall be
governed by and interpreted in accordance with the laws of the District of Columbia applicable to
agreements executed and fully carried out within the District of Columbia. I acknowledge that no other
party nor any agent or attorney of any other party has made any promise, representation or warranty
whatsoever, express or implied, not contained herein concerning the subject matter hereof, to induce me
to execute this document and I acknowledge that I have not executed this instrument in reliance on any
such promise, representation or warranty not contained herein.

BY SUBMITTING MY VIDEO, I CERTIFY THAT I HAVE READ THE FOREGOING


AFFIDAVIT AND LIABILITY AND PUBLICITY RELEASE PRIOR TO ITS EXECUTION AND
THAT I FULLY UNDERSTAND ITS CONTENTS. I FURTHER CERTIFY THAT THE
STATEMENTS I HAVE MADE IN THIS AFFIDAVIT ARE TRUE AND OF MY OWN
PERSONAL KNOWLEDGE.

Signature: ____________________________

Name: ____________________________

Address: ____________________________

____________________________

Phone: ____________________________

SSN/Date of Birth:_____________________

User Log-in Name: ___________________

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