A consent form for the #purposedfutured campaign

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 record-
ings 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 can 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_________________________