Online Consent Form - MePACS Media

GENERAL MEDIA CONSENT FORM

FOR EDUCATION AND PROMOTION OF MePACS Personal Alarms

Event Description:

Interview for Advertising / Website
Photo Opportunity for Testimonial
Quote for Marketing Purposes
Filmed Interview

We will use the information you have given us today to publicise the activities of MePACS, and we may use the content in the future for a number of purposes such as social media, the website, brochures and media releases.

To ensure we have your permission to use this information and/or your photo, we ask you to sign this form.

Please read this form carefully before signing.

Terms and Conditions of Consent

Full Name*
Address*
Contact number*
Email*
Date*
Consent*
I agree to the terms and conditions.
By agreeing for MePACS to use the information you have given, you will consent to the use of this information without any personal compensation or remuneration.

You will forgo any rights to the information, including copyright. Peninsula Health and MePACS agree not to use any information in a manner that may be deemed adverse or defamatory to the person signing this form. The information will remain the property of MePACS. On some occasions, for instance publication in a newspaper, your first name will be provided to explain who has given the information.

I have read and agree to the terms and conditions.

Online Consent Form – MePACS Media