Consent to use photography and multimedia

For individual (registered) members

Over 18(Required)
Consent(Required)
  1. My photograph, digital image, quotation or digital recording may be published in a variety of formats including printed publications (such as brochures and newsletters) and electronically including on the website.
  2. My full name may be used in some cases to describe the content of the photograph.
  3. I may contact the Heartbeat Victoria Council Inc. or a branch or affiliate, as appropriate, in writing to request that my photograph or multimedia and name no longer be used in future publications. On request the Heartbeat Victoria Council Inc. or a branch or affiliate will cease to use my photograph or multimedia and name, but is not required to withdraw all current publications (already featuring my photograph or multimedia and name) from circulation.
  4. The Heartbeat Victoria Council Inc. or a branch or affiliate will use my photograph or multimedia respectfully and may alter and modify, only if appropriate.
  5. I will not receive any payment or royalties from the Heartbeat Victoria Council Inc. or a branch or affiliate for the use of my photograph or multimedia.
Aboriginal or Torres Strait Islander
Consent
Membership application
Current member
DD slash MM slash YYYY

If you would prefer to use a printable version you can download the pdf and submit it to Heartbeat Victoria Council Inc, PO Box 144, Parkville VIC 3052 or email hello@heartbeatvictoria.org.au