Media Consent

Thank you for helping us promote the work of Nottingham Hospitals Charity and the difference our donors and supporters help us make. Please fill in the details below:

I hereby give my consent to be interviewed/photographed/filmed by the media.

Name of interviewee

Date of interview

Location / Event

Name of Guardian (if applicable)

Address

Phone number

Email address

Signature of interviewee / guardian

I herby give my consent to be photographed / videoed by Nottingham Hospitals Charity, Nottingham University Hospitals NHS Trust and/or the media. By giving consent you giving Nottingham Hospitals Charity permission to use this material for Charity publicity purposes. This may include material seen by the general public such as; leaflets, reports, social media, newspapers and magazines.

The information you give on this from will not be recorded for any other purpose. If you would like us to keep in contact with you and add your information to our database so that we can contact you about our funded projects, appeals, events and ongoing activities, please let us know how you would like to hear from us.

You can unsubscribe at any time, please see our privacy statement for more information about how we use and store your data.

OK to Email

YesNo

OK to Post

YesNo

Ok to Phone

YesNo

Media Consent

Keep up to date