For reference. You can get in touch with us regarding queries

1.
Individual consent for the publication of image and
information
I,
_____________________________________________________________________________________
hereby give my permission to use (tick):
Picture / photo ❏ Yes ❏ No • Name / organization ❏ Yes ❏ No
for the purpose of communication in the event Global Service Jam, both the edition of 2012 and in future
editions organized by ThoughtWorks India Pvt. Ltd. Possible uses include but are not limited to, reports,
brochures, newsletters, web pages, multimedia presentations and displays and to use other means of
communication in relation to public announcements.
Contact details to appear in such promotional material / web sites are:
Name / Organization:
_____________________________________________________________________________________
Profession:
_____________________________________________________________________________________
I understand that:
• The publication will appear on the Internet;
• The publication will appear in print, electronic, video and / or media;
• The publication can allow readers to identify the participant.
Important - Please note:
By giving your consent, you should keep in mind that the information published on the Internet is
accessible to millions of users around the world, indexed by the search engines and can be copied and used
by any web user. This means that once the photograph is published on the Internet, Soulsight has no control
over its subsequent use and disclosure.
The information on this form is collected in order to obtain your consent for the publication of his image.
The information collected on this form will be used for the purpose for which it has provided and will not
disclose it without your consent.
Name:
_____________________________________________________________________________________
Date: February 2012 _____
Signature:
Phone: _____________ Email: ____________________________________________________________
Note: The description of the / s image / s will be "Gurgaon Service Jam"