Publicity consent form

Authorisation to use and disclose images and personal information.
By ticking and submitting this form, I authorise Indigenous Business Australia (IBA), its directors, employees, contractors, and agents to collect, store, release, disclose and utilise my name, my personal information (including sensitive information), sayings and quotes, any images and recordings of me for advertising, promotional and educational purposes, including but not limited, to:
  • print media such as publications, brochures, newspapers, reports, news stories and media release;
  • audio visual recordings and;
  • internet based media such as websites, social media and web pages.
I understand that the promotional material and publications referred to above may be disseminated widely (in full or as edited portions) within the public domain (including Government departments and agencies), and that once my information or image has entered the public domain, it may be used by third parties without my further knowledge or authorisation. I also understand that by giving this authority I may (in some instances) lose any intellectual property or ownership rights I may have with respect to the above, including photos, sayings and quotes and audio and visual recordings. I release IBA from all liability for any loss, claims, demand, injury, or expense that arise from or are related to third parties using my information or image.
(Note: You do not have to agree to the terms of this document, and you may wish to obtain independent legal advice before signing this document)

A copy of your completed form will be sent to your email on submission.