A consent form for interviews by contributors to the June 2011 #purposedfutured campaign. http://purposed.org.uk

1. 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_________________________