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Manifest Destiny III Freeway Signs Sculpture Painting Minimum Wage Poster For the War Effort


Application: The 59 Star Flag
>made in the USA

A deposit will be required. Upon receipt of a deposit, a flag and release forms will be sent to you
postage paid, with a self addressed stamped envelope. The $600. deposit will be refunded in full
upon delivery of a videotaped (Hi8, Mini DV or DVD) installation and a release form.

The quickest way to get started is with PayPal, click the Buy Now button,
or to remain anonymous complete the form below.


Since May 11, 2002. Confirmation at the following Link: >

 Or You May:

Complete the form below, you are NOT obligated to use your real name, you are NOT obligated to fill out the email,
or phone number. (there is a strict NO SPAM policy, your mailing address, email address, or phone number will
never be sold to a third party)

The mailing address MUST be correct to receive a flag, and a $600.
(US currency) deposit is required.

mailing address:
street, unit no., city, zip


>contact: Richard Ankrom

Check List:

1.) Return mailing address

2.) $600. deposit

3.) Release Form

4.) Hi8, Mini DV videotape or DVD



This is a sample, two (2) copies will be sent with a flag postage paid. Keep one (1)
release for your records, send one (1) signed release back with a videotape (Hi8, Mini DV)
or DVD of the installation. All terms are negotiable.


(Document must be signed by everyone who works on or appears in (except for public crowd shots)
a Submission and by the Producer(s))

“Person appearing / working / submitting” = _______________________________________________________________________
[Print name(s) of Person(s) creating and submitting a Submission only]

By signature below, each of the undersigned signifies his or her agreement as follows: For good and valuable consideration, including the possibility of publicity, the receipt and sufficiency of which is hereby acknowledged, I hereby irrevocably grant to Producer all services and appearances rendered by me, and all ideas and materials provided by me, in connection with the development, production and/or exploitation of print, graphic, audio and/or visual or other content, projects, productions, campaigns and/or programs relating to RICHARD ANKROM. My services are a “work-for-hire” as that term is used in copyright law. I hereby irrevocably give and grant to Producer all rights of every kind and character whatsoever in all media and languages now known or hereafter devised (including, but not limited to, film, television, videocassettes, interactive devices and Internet and on-line systems) throughout the world, in perpetuity, in and to all work done, and all poses, acts, plays and appearances made by me, my voice and instrumental, musical or other sound effects produced by me, and in and to all of the results and proceeds of my services as well as in and to the right to use my name, likeness and photographs, either still or moving, for all commercial and non-commercial purposes (including, but not limited to, merchandising, advertising and promotion purposes). Without limiting the foregoing, I further irrevocably give and grant to the Producer Parties the right to adapt, change, edit, modify, add to, delete, combine with other materials, record, reproduce, distribute and otherwise exploit the same by any means now known or hereafter devised. Producer and the Producer Parties may freely assign or transfer its rights hereunder, in whole or in part. I hereby irrevocably agree that I will not assert nor maintain against the Producer, its licensees, successors or assigns, or any of their directors, officers, employees or representatives (“Producer Parties”), any claim, action, suit or demand of any kind or nature, whatsoever, including, but not limited to, those grounded upon invasion of privacy or of publicity or any other rights (including, without limitation, intellectual property rights), defamation, libel or slander or for any other reason in connection with the exercise of the rights granted herein. I realize that Producer is relying upon this Release in using me in the making of the Project and, accordingly, I hereby irrevocably waive any and all rights to seek or obtain any injunctive or other equitable relief against any of the Producer Parties. I further acknowledge and agree that any breach by me of this Release will cause Producer Parties irreparable harm, and therefore, that each of the Producer Parties will be entitled to injunctive or equitable relief (without the need to post bond or surety or show harm) in addition to all other remedies available at law or in equity, in any court of competent jurisdiction. The releases hereunder are intended to apply to all claims not known or suspected to exist with the intent of waiving the effect of California Civil Code Section 1542 and other laws requiring the intent to release future unknown claims. This Release will be governed by the laws of the State of California applicable to agreements executed and to be fully performed therein (without regard to the conflict of laws provisions thereof). No compensation will be paid hereunder.

Name: _____________________________________________________________________

Address: ___________________________________________________________________


Phone Number: ______________________________________________________

E-mail address: ______________________________________________________

Age: ___________ Date of Birth: month __________ day __________ year ______________

Circle one: Worked on Video / Appears in Video

If appears in video, describe personal characteristics: _________________________________


I have read and agree to the Video Submission Release.

Accepted and Agreed To By: ____________________________________________________

Dated as of: _______________________________ [Insert date of or prior service/appearance]

Signature: (Richard Ankrom, Producer) ______________________________________________

Signature: (Person appearing / working / submitting) ____________________________________

NOTE: If possible, obtain a copy of a driver’s license or other positive identification for each of the above
listed people and attach hereto. If any individual is under 18 years of age, the attached Parental Consent to
this Release must be signed by a parent or legal guardian on behalf of the minor. Document may be reproduced as needed.


This is a sample, two (2) copies will be sent with a flag postage paid. Keep one (1) release for your records, send one (1) signed release back with a videotape (Hi8, Mini DV) or DVD of the installation. All terms are negotiable.

Thank You


Manifest Destiny III Freeway Signs Sculpture Painting Minimum Wage Poster For the War Effort

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