Photography / Media Consent and Release Form

Photography / Media Consent and Release Form
I hereby grant permission to Far North Training & Consultancy, its employees, and representatives to use my image in media productions such as photographs/digital images, video tapes, and audio tapes.

I agree to be identified by my name and organisation.

I authorise Far North Training & Consultancy to use, reuse, copy, publish, display, exhibit, reproduce and distribute the materials for educational and promotional purposes in press releases, publications, website articles, and other media outlets without notifying me.

I agree that I am participating on a voluntary basis and I will not receive any payment from Far North Training & Consultancy for signing this consent and release or as a result of any publication of the materials.

I agree to provide in writing, if I no longer wish to be featured in any of the material used by Far North Training & Consultancy.
Student Name / Organisation Representative Name*

First NameMiddle NameLast Name
Organisation Name
If FNTC student, please write "Student"
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty: