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Ggn servicejam individual consent

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Ggn servicejam individual consent

  1. 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 ❏ Nofor the purpose of communication in the event Global Service Jam, both the edition of 2012 and in futureeditions 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 ofcommunication 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 isaccessible to millions of users around the world, indexed by the search engines and can be copied and usedby any web user. This means that once the photograph is published on the Internet, Soulsight has no controlover 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 notdisclose it without your consent.Name:_____________________________________________________________________________________Date: February 2012 _____Signature:Phone: _____________ Email: ____________________________________________________________Note: The description of the / s image / s will be "Gurgaon Service Jam"