Media Release Form

Your name

Your home address

Date of event

Mobile number

Your email address

Event title

I.e. Photoshoot, video production.

I grant permission to the University of Adelaide to use, reproduce and communicate (in hardcopy or electronic format) any photographs, audio and/or video recordings taken of me on the date below, for the following purposes:

University publications and promotional activities (including but not limited to the University’s website and social media sites, promotional and marketing materials and student recruitment activities);
the University’s administrative and teaching purposes

I acknowledge and agree that this may result in public disclosure of my image.

Signature

Sign above