CONSENT FORM

VENUE………………………………………………………………………………………………..

DATE……………………………………………………………………………………..…………...

CREATOR OF RECORDING………………………………………..………

This form is to be signed by the person who has agreed to be recorded as part of an interview carried out on behalf of Purpos/ed (http://purposed.org.uk).  This reason for this form is to seek consent for the recordings to be taken and subsequently to be used in a number of media, including online activity, by Purpos/ed.  In turn, Purpos/ed offers a commitment to allow, to the best of their ability, said recordings to be used appropriately and sensitively.

I, the undersigned, agree to my interview being recorded in audio format on behalf of Purpos/ed. I understand that any copyright or other intellectual property which arises in the recording belongs to Purpos/ed and that the recording may be converted into other formats and published at http://purposed.org.uk and other social media channels.

I, the undersigned, do hereby agree to license/assign all performance rights in the film and/or recordings of lectures to Purpos/ed. I also agree to waive all moral rights in my performance in the film and/or recordings of lectures to Purpos/ed.

I, the undersigned, consent to the use of my personal data being processed for the purposes of this recording and subsequent publishing. My personal data will be processed in accordance with the provisions of the data Protection Act 1998. I understand that copyright in the recordings will be retained by Purpos/ed.

I understand that Purpos/ed shall release the interview under a Creative Commons license which may mean that it will be re-used, edited or amended without prior permission from myself or Purpos/ed.

FULL NAME ______________________________________________________________

NAME OF ORGANISATION __________________________________________________

CONTACT TELEPHONE_____________________________________________________

EMAIL ADDRESS __________________________________________________________

SIGNED ___________________________________DATED_________________________