Photography and Film consent form Thank you for helping us by allowing your name and image to be used in future communication materials. If you have any questions or reservations after signing this consent form please do not hesitate to contact us. Your details Your details First name First name Last name Last name Email Phone number Address Address line 1 Address line 2 Address line 3 City Postcode Country How we might use your image in the future How we might use your image in the future The Royal Marsden* may use your images after the initial consent form has been signed in different communication materials. This includes literature; posters and exhibition displays; our website, social media, or in communication material such as adverts in trade or consumer press or online (this is not exhaustive). Images/film footage may be used by external companies, commissioned or employed by The Royal Marsden, for the production or publication of materials, on behalf of The Royal Marsden. *The Royal Marsden includes The Royal Marsden NHS Foundation Trust, The Royal Marsden Cancer Charity, The Royal Marsden Private Care, The Royal Marsden School and The Royal Marsden Community Services. Please send all enquiries to: Tel: 020 7808 2233 Email: [email protected] Your consent By checking the box below, you are consenting to the following: I authorise The Royal Marsden to use my name and image in communications (including publicity material). I understand that I will be identifiable and could be named in relation to the image and the image will be used without any further discussion unless I or my next of kin withdraws consent in writing to: [email protected]. I consent to my image and contact details as listed above to be stored for future use and contact. I understand that if my consent is withdrawn, The Royal Marsden will use its reasonable endeavours to destroy or delete any identifiable images of me. I have read this form carefully and understand its meanings and implications. I acknowledge that by signing this form I give The Royal Marsden full copyright and authority to publish the photographs and agree with the terms listed above. I have read this form and consent to my image being used. I acknowledge that by checking this box I consent to the terms listed above Complete
