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Spring 2010 - Child Star Contest

EMAIL SubmitCableMuse@msn.com, FAX (888) 805-8481 or MAIL THE SIGNED CONSENT FORM BELOW:

I hereby grant permission to Cable Muse Network LLC (CMN) to use my name, likeness and/or voice, or the name, likeness and/or voice of my minor child for all publicity purposes and in any media format. Media formats include, but are not limited to: newspapers, magazines, television, radio, film, or on the Internet. CMN shall retain all rights to all materials submitted.

Name (print): ___________________________________________ 
Signature: ___________________________________________ 
Witness ___________________________________________ 
Email Address:________________________________________ 
Cell or Home Phone Number:_____________________________
Name or “nickname” to be used for a minor: ______________________ 
Age: ___
Location (City, State)_____________________
Date: ___/____/2009
Submission Reference: name of your video submitted or YouTube location(s): 
___________________ If a CD is mailed to below note "Mail"

Cable Muse Network, LLC
P.O. Box 33443
Phoenix, AZ 85067-3443
(888) 805-8481
www.cablemuse.com

Cable Muse Network LLC employees and their families may submit entries however are not eligible to win contest prizes.  

Copyright 2008, 2009, 2010, 2011, 2012 Cable Muse Network, LLC. All rights reserved.