Media Consent Form

In this form, you can state your agreement authorising Leor to use photographs and videos of yourself on various social media platforms.

Your Name*
Full Name
Email*
Date*
DD slash MM slash YYYY
Agreement
I authorise Leor Pty Ltd to take and use photographs and video of myself ('Images').*
- Yes
- No
I authorise Leor Pty Ltd to use the Images for commercial purposes, including but not limited to, use on websites, social media, publications, and exhibition/conference collateral. I give permission for my image to be used for promotional and marketing purposes print, on screen, electronic and digital publications; on the Leor website, social media platforms; by 3rd Party media partners selected by Leor to promote the organisation and its work, services, products and future products; for promotional purposes by organisations affiliated with Leor, including affiliate marketing firms, media and creative agencies, brokers, suppliers and business partners to use these images for promotional purposes only.*
- Yes
- No
I acknowledge that Leor Pty Ltd has exclusive commercial use of these Images and that any use of the Images by me will be for personal use only.*
- Yes
- No
I acknowledge that Leor Pty Ltd will take all reasonable steps to prevent other individuals or organisations from copying the Images from its materials for unauthorised use, however, Leor Pty Ltd will not be held liable for any damages arising out of the unauthorised use of the Images.*
- Yes
- No
Your Signature*

Phone: 02 9051 0511
Email: learn@leor.com.au

Agreement