PHOTOGRAPH AUTHORIZATION, CONSENT AND RELEASE FORM
Axial Spondyloarthritis International Federation
Axial Spondyloarthritis International Federation (ASIF) is seeking authorization to use the image (photograph, video or art) featuring you to support ASIF’s World AS Day and other awareness campaigns. ASIF will not use the images for any other purpose than those described herein.
I hereby voluntarily, without consideration or any promise of any consideration, give my authorization and consent to ASIF and its agents or representatives (collectively, “the ASIF Users”) to externally or publicly use, reuse, publish, republish, reproduce, display, broadcast or otherwise distribute any photographs I submit to ASIF, any video footage I submit to ASIF, and any art that is based on my likeness for ASIF’s World AS Day and other awareness campaigns”.
I hereby grant ASIF and/or any of the ASIF Users the permission to use the photographs, videos and/or artistic likenesses, including pre-agreed personal details such as my name and my connection to AS, in any external public relations and social media activities, and for any internal use whatsoever, including, but not limited to, educational, promotional or commercial purposes, in any medium worldwide (“the Permitted Uses”), as determined in the sole discretion of ASIFor any of the ASIFUsers. The Permitted Uses may include, but are not limited to, internal company meetings, internal materials (intranet articles, brochures, materials, posters), or for external educational, public relations or social media purposes and materials. All additional uses must be agreed upon in writing. I understand that the images will be kept for as long as necessary for the purposes described herein, however, that some images may be kept permanently once they are published for archival purposes.
By executing this Photograph Authorization, Consent and Release Form, I also hereby release ASIF and any of the ASIF Users from any and all claims, demands, liabilities, suits, judgments, damages, actions or other rights that I have, or in the future may have, arising out of or from the use of such photographs, video footage or photographic likenesses of me in connection with the Permitted Uses.
This Photograph Authorization, Consent and Release contains the full terms of my authorization, consent and release intended hereby and may not be modified except in writing signed by both me and ASIF.
I have read and understand the conditions and consent to my images being used as described.
You have the right to request access to the information we hold about you and to request corrections or deletions of information that is no longer required. You have the right to withdraw your consent at any time by contacting ASIF, in which case the image(s) featuring you will not be used in future materials but may continue to appear in materials already in circulation.
You have the right to lodge a complaint regarding data protection issues with the supervisory authority in your country.
If you have any questions relating to this consent form or the way we are planning to use your information please contact: firstname.lastname@example.org.