Media Consent Form – Adult Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Comment or Message *Terms of Media Consent *By clicking Submit I agree to electronically sign this formThis media consent form applies to all individuals. The Privacy Amendment Act 2001 imposes obligations upon organisations collecting personal information to protect that information. GUIH carries out ongoing marketing and communication activities to maintain a positive profile. Images of individuals in photographs or film are treated as personal information under the Privacy Act where the person’s identity is clear or can reasonably be worked out from that image. Photos and video footage are used regularly by GUIH for a number of purposes and under current legislation this practice can continue. Consent Written consent will be sought from individuals to identify them (by image or name) for marketing and/or promotional purposes. The individual will be required to complete and sign the GUIH Media Consent Form. This consent, once given, will be amended or revoked only upon receipt of written notification from the individual who gave it originally. An individual should notify GUIH immediately if any circumstance arises that would prevent GUIH using an individual's photo, video images or work samples. Remuneration No remuneration is offered to individuals for whom consent is given. Copyright At all times ownership of any material obtained from the above activities will vest with GUIH. Consent Given I give permission for photos, video/audio and samples of work created or contributed to by the person below to be used without remuneration or compensation in publications (print, websites, social media) and/or presentations sanctioned by GUIH. Purpose This consent applies to any use, recording or disclosure of the individual’s name, recording or image, individual work and personal information, including but not limited to: • Public relations, promotion, advertising, media and commercial activities; • Use by the media in relation to activities that show the Individual in a positive light; • Any other activities as sanctioned by GUIH Duration I acknowledge that the material may continue to be used for a number of years and that some of the products in which the material is used may have extended longevity. Understandings • ‘Use’ includes: - to create, make copies of or reproduce or retain in any form, including by camera, video, webcam, closed circuit television, mobile phone or any other form of digital recorder or device, including still or motion; and - to distribute, publish or communicate in any form, including in newsletters and other print media, television and the Internet, in whole or in part, and to permit other persons to do so. Any personal information will be stored, used and disclosed in accordance with the requirements of the Privacy Amendment Act 2001 (Cwlth). GUIH ACN: 650 878 103 Submit